Even as newer and more powerful drugs have improved tuberculosis treatment in recent years, experts say major diagnostic and clinical challenges continue to complicate the management of multidrug-resistant tuberculosis (MDR-TB) among people living with HIV.
Speaking at ASICON 2026, the 17th National Conference of the AIDS Society of India in Mumbai, infectious diseases specialist Dr Trupti Gilada highlighted the complexities of treating patients affected by both HIV and TB.
Presenting a session titled ‘New TB Drugs, Old Problems: Navigating MDR-TB in HIV’, she said the intersection of the two infections remains one of the most difficult challenges in infectious disease care.
“Despite advances in TB therapeutics, diagnosing and managing MDR-TB in HIV patients remains complex due to atypical disease presentation, delayed diagnosis and rapid progression of illness,” she said.
Tuberculosis remains the leading cause of death among people living with HIV worldwide, with drug-resistant strains making treatment more difficult.
India continues to have the world’s highest TB burden, and people with HIV face a significantly higher risk of multidrug-resistant TB (MDR-TB), which experts say occurs about twice as often in HIV-positive individuals.
Undiagnosed TB also contributes to early deaths among patients starting antiretroviral therapy.
Drug-resistant TB ranges from mono-resistant and rifampicin-resistant TB to MDR-TB and more severe forms such as pre-XDR and XDR TB.
Newer drugs, including bedaquiline and linezolid, now form the backbone of modern treatment regimens alongside medicines such as moxifloxacin, levofloxacin, clofazimine, cycloserine and delamanid.
However, diagnosis remains difficult because TB often presents atypically in HIV patients, with minimal X-ray findings, negative sputum tests or extra-pulmonary disease.
Experts emphasised rapid tests such as GeneXpert and genome sequencing to detect resistance early, along with stronger integration of TB and HIV programmes and wider access to modern treatments.
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