Treatment of latent M. tuberculosis infection and use of antiretroviral therapy to prevent tuberculosis
Timothy R. Sterling, Philana Ling Lin
Timothy R. Sterling, Philana Ling Lin
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Commentary

Treatment of latent M. tuberculosis infection and use of antiretroviral therapy to prevent tuberculosis

Abstract

Even with treatment of HIV with antiretroviral therapy (ART), the risk of tuberculosis (TB) reactivation remains higher in HIV-infected than HIV-uninfected persons. In this issue of the JCI, Ganatra et al. explored TB reactivation in the context of ART using TB and simian immunodeficiency virus–coinfected (TB/SIV-coinfected) nonhuman primates. The authors found that treating rhesus macaques with ART restored CD4+ T cells in whole blood, spleen, and bronchoalveolar lavage (BAL) fluid, but not in the lung interstitium. TB risk was not decreased in the coinfected macaques treated with ART for 14–63 days, suggesting that ART does not decrease the short-term risk of reactivation. Reactivation occurred as CD4+ T cells were increasing, which is consistent with observations made in humans. This study provides a potential model for systematic evaluation of TB/SIV coinfection and different treatment regimens and strategies to prevent TB reactivation.

Authors

Timothy R. Sterling, Philana Ling Lin

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Figure 1

Factors associated with M. tuberculosis and HIV coinfection that affect the risk of developing active TB.

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Factors associated with M. tuberculosis and HIV coinfection that affect ...
In TB/HIV-coinfected individuals, recent infection with M. tuberculosis, longer duration of HIV infection, associated lower CD4+ T cell counts, and recent HIV ART increase the risk for developing TB. Conversely, treatment for M. tuberculosis infection, infection with M. tuberculosis before subsequent reexposure to TB, and prolonged HIV ART decrease the risk for TB. Notably, immune recovery relates to the risk for reactivation; restoring effective resident T cells in the lungs may require longer ART durations. These factors could be evaluated in the macaque model used in Ganatra et al. (18) to assess ways to optimally decrease TB risk.