HIV and tuberculosis as a syndemic: Clinical characteristics and outcomes from a tertiary care centre in the Republic of Srpska (2016-2026)

Introduction: Coinfection with HIV and tuberculosis (TB) represents a significant clinical and public health challenge, as tuberculosis remains one of the leading opportunistic infections among people living with HIV. Immunosuppression caused by HIV infection increases the risk of developing active tuberculosis as well as disseminated and severe clinical forms of the disease. The aim: This study aimed to analyze the prevalence, clinical characteristics, and outcomes of HIV-tuberculosis coinfection among patients treated at a tertiary care center in the Republic of Srpska. Methods: A retrospective study was conducted, including patients diagnosed with HIV infection between 2016 and 2026 who were treated at the Clinic for Infectious Diseases, University Clinical Center of the Republic of Srpska. Demographic data, clinical characteristics, CD4 lymphocyte counts, the presence of active or latent tuberculosis, comorbidities, and treatment outcomes were analyzed. Results: The study included 103 patients with HIV infection. Mycobacterium tuberculosis infection was confirmed in 21 patients (20.38%). Active tuberculosis was diagnosed in 5 patients (4.85%), while latent tuberculosis infection was identified in 16 patients (15.53%) using the IGRA test. All patients with active tuberculosis were male, predominantly aged 20-40 years, with a mean CD4 lymphocyte count of 48 cells/µL. The most common clinical form was cavitary pulmonary tuberculosis. Latent tuberculosis was more frequently detected in patients aged 40-60 years, with a mean CD4 count of 295 cells/µL. Conclusion: Although the overall prevalence of tuberculosis among people living with HIV is relatively low, coinfection remains a significant clinical challenge due to its association with advanced immunosuppression and severe clinical forms of disease. Early screening for latent tuberculosis and timely initiation of preventive therapy represents key strategies for reducing morbidity and mortality in this population.