The Mtb-HIV syndemic interaction: why treating M. tuberculosis infection may be crucial for HIV-1 eradication

Robyn Waters; Mthawelanga Ndengane; Melissa-Rose Abrahams; Collin R Diedrich; Robert J Wilkinson; Anna K Coussens

doi:10.2217/fvl-2019-0069

The Mtb-HIV syndemic interaction: why treating M. tuberculosis infection may be crucial for HIV-1 eradication

Future Virol. 2020 Feb;15(2):101-125. doi: 10.2217/fvl-2019-0069.

Authors

Robyn Waters^{1

2}, Mthawelanga Ndengane^{1

3}, Melissa-Rose Abrahams^{1

3}, Collin R Diedrich⁴, Robert J Wilkinson^{1

2

5

6}, Anna K Coussens^{1

3

7

8}

Affiliations

¹ Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease & Molecular Medicine, University of Cape Town, Observatory 7925, WC, South Africa.
² Department of Medicine, University of Cape Town, Observatory 7925, WC, South Africa.
³ Department of Pathology, University of Cape Town, Observatory 7925, WC, South Africa.
⁴ Department of Pediatrics, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
⁵ Department of Infectious Diseases, Imperial College London, London W2 1PG, United Kingdom.
⁶ The Francis Crick Institute, London NW1 1AT, United Kingdom.
⁷ Infectious Diseases and Immune Defence Division, The Walter & Eliza Hall Institute of Medical Research, Parkville 3279, VIC, Australia.
⁸ Division of Medical Biology, Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Parkville 3279, VIC, Australia.

Abstract

Accelerated tuberculosis and AIDS progression seen in HIV-1 and Mycobacterium tuberculosis (Mtb)-coinfected individuals indicates the important interaction between these syndemic pathogens. The immunological interaction between HIV-1 and Mtb has been largely defined by how the virus exacerbates tuberculosis disease pathogenesis. Understanding of the mechanisms by which pre-existing or subsequent Mtb infection may favor the replication, persistence and progression of HIV, is less characterized. We present a rationale for the critical consideration of 'latent' Mtb infection in HIV-1 prevention and cure strategies. In support of this position, we review evidence of the effect of Mtb infection on HIV-1 acquisition, replication and persistence. We propose that 'latent' Mtb infection may have considerable impact on HIV-1 pathogenesis and the continuing HIV-1 epidemic in sub-Saharan Africa.

Keywords: AIDS; HIV-1 cure; granuloma; immune activation; latency; transmission; tuberculosis; viral expansion; viral reservoir.

Publication types

Review