TB and HIV: A Deadly Duo

Tuberculosis (TB) claimed 1.6 million lives in 2021, including of 187,000 people living with HIV, making it the second leading infectious disease killer after COVID-19. And an estimated 10.6 million people fell ill with TB, mostly in low- and middle-income countries.

While 85% of people with pulmonary and extra-pulmonary TB disease can be cured in four to six months, the variations in approaches to treating TB and increasing drug-resistance to standard medicines make it more challenging to manage. The lengthy drug regimens for TB may expose patients to serious side effects, like liver and kidney injury. Additionally, following treatment, people may be at increased risk for post-TB lung disease—such as chronic obstructive lung disease and secondary non-TB infections—as well as at increased risk of death.

TB is the most common opportunistic infection among people living with HIV, and those being co-treated for HIV and TB are at higher risk for side effects from the overlapping regimens and interactions between HIV and TB medicines. For those who initiate antiretroviral therapy while being treated for TB, additional challenges may arise due to immune reconstitution inflammatory syndrome, which is when the recovery of the immune system that occurs after HIV treatment makes TB disease worse. Globally, people living with HIV are more likely to have poor TB treatment outcomes compared to people without HIV.

A new prospective cohort study being implemented through the IeDEA HIV research consortium (iedea.org) will assess pulmonary TB treatment and longer-term outcomes to inform TB treatment policy and practice. Called the Tuberculosis Sentinel Research Network (TB-SRN), researchers also aim to create a platform for expanding TB research within IeDEA that will allow them to fill in knowledge gaps around understudied populations, including adolescentsand young adults, and pregnant and post-partum individuals with TB.

Specifically, researchers will:

• collect and analyze clinical and treatment data among people treated for pulmonary TB with or without HIV-co-infection, in order to improve understanding of the prognosis of TB disease and its health-related outcomes, including quality of life and survival;
• assess the individual-level effects of HIV and ART on TB symptoms, diagnosis, treatment response, and survival; and
• describe post-TB lung disease and associations with HIV infection, diabetes, chronic lung disease, and tobacco and alcohol use, including measuring lung impairment, health-related quality of life, and survival.

An estimated 2,600 participants aged 15 and older are being recruited at 17 TB-SRN sites around the world. The Asia-Pacific cohort will be led by amfAR’s TREAT Asia program and the Kirby Institute at the University of New South Wales, Sydney, Australia, which co-direct the Asia-Pacific section of IeDEA.