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Acquired immunodeficiencies and tuberculosis: focus on HIV / AIDS and diabetes mellitus
Author(s) -
Ronacher Katharina,
Joosten Simone A.,
Crevel Reinout,
Dockrell Hazel M.,
Walzl Gerhard,
Ottenhoff Tom H. M.
Publication year - 2015
Publication title -
immunological reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.839
H-Index - 223
eISSN - 1600-065X
pISSN - 0105-2896
DOI - 10.1111/imr.12257
Subject(s) - tuberculosis , diabetes mellitus , human immunodeficiency virus (hiv) , immunology , immunopathology , virology , focus (optics) , biology , medicine , pathology , endocrinology , physics , optics
Summary The spread of human immunodeficiency virus ( HIV ) infection within Africa led to marked increases in numbers of cases of tuberculosis ( TB ), and although the epidemic peaked in 2006, there were still 1.8 million new cases in 2013, with 29.2 million prevalent cases. Half of all TB cases in Africa are in those with HIV co‐infection. A brief review of the well‐documented main immunological mechanisms of HIV ‐associated increased susceptibility to TB is presented. However, a new threat is facing TB control, which presents itself in the form of a rapid increase in the number of people living with type II diabetes mellitus (T2 DM ), particularly in areas that are already hardest hit by the TB epidemic. T2 DM increases susceptibility to TB threefold, and the TB burden attributable to T2 DM is 15%. This review addresses the much smaller body of research information available on T2 DM ‐ TB , compared to HIV ‐ TB comorbidity. We discuss the altered clinical presentation of TB in the context of T2 DM comorbidity, changes in innate and adaptive immune responses, including lymphocyte subsets and T‐cell phenotypes, the effect of treatment of the different comorbidities, changes in biomarker expression and genetic predisposition to the respective morbidities, and other factors affecting the comorbidity. Although significant gains have been made in improving our understanding of the underlying mechanisms of T2 DM ‐associated increased susceptibility, knowledge gaps still exist that require urgent attention.