Two infections that most people think of as separate keep turning up in the same bodies.
HIV weakens the body's defences, which lets tuberculosis (TB) germs that were lying quiet wake up and cause disease, and TB can in turn speed up HIV.
According to the World Health Organization (WHO), the two make a deadly partnership, with each one pushing the other forward.
About a quarter of the world's people have been infected with TB bacteria at some point, WHO's tuberculosis fact sheet of 24 March 2026 states.
Most of them feel fine and cannot pass the germ on, because the immune system, the body's defence force, keeps it locked down.
The same fact sheet says only 5 to 10 percent of infected people eventually develop TB disease.
A weakened defence force changes that.
WHO's HIV fact sheet of 27 July 2026 says the virus targets the body's white blood cells, which weakens the immune system and makes it easier to get sick with diseases like TB.
With the guards weakened, the sleeping germ can multiply and make the person ill.
Worldwide, people living with HIV are 12 times more likely to fall ill with TB than people without HIV, as per the WHO tuberculosis fact sheet.
The harm runs both ways.
Kenya's Division of Tuberculosis and Other Lung Diseases, part of the Ministry of Health, said in its 2023 annual report that TB disease can push HIV forward quickly in patients who are not on treatment.
WHO's Africa regional office adds that, without proper treatment, nearly all people who have both TB and HIV will die, compared with 45 percent of TB patients without HIV, on average. These are global averages.
An estimated 10.7 million people fell ill with TB across the world in 2024, and about 619,000 of them were living with HIV, according to WHO's Global Tuberculosis Report 2025, released on 12 November 2025.
That is 5.8 percent, or roughly 6 in every 100 TB patients worldwide.
The same report says the global share peaked at 17 in every 100 in the year 2000, so it has fallen a long way.
The deaths are global figures too.
TB was the leading killer of people with HIV in 2024, and about 150,000 deaths from TB occurred among people with HIV that year, out of 1.23 million TB deaths worldwide, WHO reported.
WHO's Global Tuberculosis Report 2025 estimated that 2.62 million people fell ill with TB in the WHO African Region in 2024, and about 428,000 of them were living with HIV.
That is roughly 16 in every 100 TB patients in the region, against 5.8 in every 100 worldwide, and it makes up about 7 in every 10 of all the people with HIV who fell ill with TB across the world.
The report adds that the share rose above 50 percent in parts of southern Africa.
The WHO African Region is mostly sub-Saharan Africa and includes Kenya.
The region also holds most of the world's people living with HIV.
WHO's HIV fact sheet of 27 July 2026 says 64 percent of the estimated 41 million people living with HIV at the end of 2025 live in the African Region.
WHO's global fact sheet says the region accounted for 25 percent of all new TB cases worldwide in 2024. I found no Africa-only death figure for TB with HIV, so none is given here.
Kenya shows how uneven the picture can be inside one country.
The Ministry of Health's tuberculosis division reported in its 2023 annual report that 25 percent of people with TB in Kenya in 2023 also had HIV, up from 23 percent in 2022, although the report's executive summary gives the 2023 figure as 24 percent.
The share was far higher in western Kenya, at 57 percent in Kisumu, 53 percent in Homa Bay, 52 percent in Siaya and 40 percent in Busia, while Mandera and Wajir in the north east stood at 3 percent and 1 percent.
The same report showed that Kenyans with both infections did less well on treatment.
Of the patients who started treatment in 2022, 84 percent with both infections were treated successfully, against 89 percent of TB patients without HIV.
Treating HIV is the first line of defence.
A review of 11 studies from developing countries, led by a WHO researcher and published in PLoS Medicine in July 2012, found that HIV treatment, known as antiretroviral therapy (ART), was linked to a 65 percent lower risk of TB in adults with HIV.
The benefit appeared at every level of immune strength the studies measured.
Preventive medicine adds a second layer. TB preventive treatment is medicine given to people at higher risk of TB, including people living with HIV, once active TB has been ruled out, so that the sleeping germ does not wake.
A study published in The Lancet HIV on 17 August 2026 followed 235,424 people who started HIV treatment in Haiti, Kenya, Nigeria, Uganda, Ukraine and Zimbabwe.
They began treatment between 2018 and 2021 in Haiti, Kenya, Nigeria and Ukraine, and between 2018 and 2022 in Uganda and Zimbabwe, and each person was followed for up to two years.
The preventive course tested was six months of the drug isoniazid. People who started it within eight weeks of entering HIV care had a 61 percent lower risk of TB and a 45 percent lower risk of death from any cause than similar people who never received it.
The TB result was consistent from country to country, while the death result was not.
The drop in TB risk was 65 percent in Haiti and 40 percent in Kenya, the two ends of the range, and the study found little variation across the six countries.
In Kenya the study covered 9,549 people at 14 clinics in one county in eastern Nairobi, not the whole country, and the true figure could lie anywhere between 9 and 64 percent.
The drop in death risk varied widely, from 31 percent in Zimbabwe to 75 percent in Uganda.
The team used routine patient records and a statistical method that mimics a trial, rather than a real trial, so the findings show a strong link, not final proof.
The Gates Foundation funded the study, and the authors declared no competing interests.
WHO's Africa office lists four steps as the core package: routine HIV testing for all TB patients, TB screening for people living with HIV, TB preventive treatment, and infection control in health facilities.
WHO estimates that expanding TB treatment and ART worldwide since 2005 has averted 9.8 million deaths, according to its fact sheet.
Many people are still missed. Worldwide in 2024, only 61 percent of the estimated number of people with HIV who developed TB received ART, WHO said.
TB preventive treatment reached 1.8 million people living with HIV across the world that year, which the Global Tuberculosis Report 2025 put at 58 percent coverage.
Kenya's own figures for 2023 look stronger.
Its tuberculosis division reported HIV testing for 98 percent of TB patients, ART for 98.2 percent of those found to have both infections, and preventive treatment coverage among people with HIV of 94 percent, up from 88 percent in 2022, by the programme's own measure.
The link between the two infections is strong, but the evidence shows it can be weakened, and the figures above show that testing, preventing and treating both together is work still unfinished.
Sources: World Health Organization. Tuberculosis (fact sheet). Geneva: WHO; 24 March 2026. World Health Organization. HIV and AIDS (fact sheet). Geneva: WHO; 27 July 2026. World Health Organization. Global tuberculosis report 2025, section 1.1 TB incidence. Geneva: WHO; 12 November 2025. WHO Regional Office for Africa. Tuberculosis, key facts, updated 2026. Division of Tuberculosis and Other Lung Diseases, Ministry of Health, Kenya. 2023 Annual Report. Shah NS, et al. Lancet HIV. 2026;13(10):e723-e734. doi:10.1016/S2352-3018(26)00140-2. Suthar AB, et al. PLoS Med. 2012;9(7):e1001270. doi:10.1371/journal.pmed.1001270
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