Integrated management of multidrug-resistant tuberculosis, HIV, and hepatitis B co-infection in Ghana: a case report.

Introduction: Co-infection with multidrug-resistant tuberculosis (MDR-TB) and human immunodeficiency virus (HIV) represents a major global public health challenge. The coexistence of these conditions with chronic hepatitis B infection further complicates clinical management due to overlapping drug toxicities, limited treatment options, and challenges with patient adherence, particularly in resource-constrained settings. Case presentation and clinical findings: A 37-year-old woman living with HIV presented to a clinic in Ghana's Central Region with symptoms suggestive of pulmonary tuberculosis (TB). Further evaluation led to the diagnosis of rifampicin-resistant pulmonary TB, chronic hepatitis B infection, and chronic renal impairment. Her clinical course was complicated by adverse drug reactions, chronic renal disease and intermittent interruptions in antiretroviral therapy due to drug stockouts. These factors posed significant challenges to treatment continuity and tolerability. Conclusion: Despite significant clinical and systemic challenges, the patient completed a 12-month MDR-TB regimen with documented microbiological cure. Antiretroviral therapy for HIV is ongoing, while the hepatitis B infection and chronic renal disease are under clinical monitoring without specific antiviral treatment or dialysis due to cost constraints. This case highlights the critical importance of integrated, multidisciplinary care in the management of complex co-infections. It also draws attention to persistent health system constraints, including drug shortages, limited diagnostic capabilities, and financial barriers to accessing healthcare, which must be addressed to improve outcomes for patients with similar high-risk profiles in low-resource settings.