The COVID-19, tuberculosis and HIV/AIDS: Ménage à Trois

Abstract

In December 2019, a novel pneumonic condition, Coronavirus disease 2019 (COVID- 19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), broke out in China and spread globally. The presentation of COVID-19 is more severe in persons with underlying medical conditions such as Tuberculosis (TB), Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) and other pneumonic conditions. All three diseases are of global concern and can significantly affect the lungs with characteristic cytokine storm, immunosuppression, and respiratory failure. Co-infections of SARS-CoV-2 with HIV and Mycobacterium tuberculosis (Mtb) have been reported, which may influence their pathogenesis and disease progression. Pulmonary TB and HIV/AIDS patients could be more susceptible to SARS-CoV-2 infection leading to lethal synergy and disease severity. Therefore, the biological and epidemiological interactions of COVID-19, HIV/AIDS, and TB need to be understood holistically. While data is needed to predict the impact of the COVID-19 pandemic on these existing diseases, it is necessary to review the implications of the evolving COVID-19 management on HIV/AIDS and TB control, including therapy and funding. Also, the impact of long COVID on patients, who may have this co-infection. Thus, this review highlights the implications of COVID-19, HIV/AIDS, and TB co-infection compares disease mechanisms, addresses growing concerns, and suggests a direction for improved diagnosis and general management.

Reduced HIV/AIDS diagnosis rates and increased AIDS mortality due to late diagnosis in Brazil during the COVID-19 pandemic

“…Additionally, disparities persist along ethnic lines, with AIDS rates among blacks and African Americans eight times higher than among whites 20 . Similarly, data from South Africa reflect the impact of COVID-19 on HIV, evidenced by reduced testing, including for tuberculosis 4,6,8,44 . These findings highlight the importance of considering socioeconomic disparities in regional HIV/AIDS control efforts.…”

“…Despite some contradictory data, it is evident that SARS-CoV-2 has had a detrimental impact on people living with HIV. Previous studies have shown that comorbidities increase the risk of severe clinical forms of COVID-19, including immunosuppression, cardiovascular disease, cancer, and tuberculosis 20,44,45 .…”

“…UNAIDS estimated that in 2021, one in three AIDS-related deaths was due to tuberculosis 43 . Moreover, the occurrence of COVID-19 in patients co-infected with HIV/AIDS and tuberculosis can result in more severe clinical outcomes 44 . All three diseases can significantly affect the lungs, often leading to a cytokine storm, immunosuppression, and respiratory failure.…”

Colliding Challenges: An Analysis of SARS-CoV-2 Infection in Patients with Pulmonary Tuberculosis versus SARS-CoV-2 Infection Alone

“…Individuals with pulmonary tuberculosis and HIV/AIDS might exhibit heightened susceptibility to SARS-CoV-2 infection, potentially resulting in lethal synergistic effects and increased disease severity [21]. Moreover, worldwide, it is estimated that between 10 to 25% of TB infections occur extrapulmonarily, infecting virtually any organ, thus definitive diagnosis usually requires invasive procedures and complex imaging examinations, as symptoms can be very heterogeneous [22].…”

Structure of mycobacterial ergothioneine-biosynthesis C-S lyase EgtE

“…Tuberculosis, caused by Mycobacterium tuberculosis (Mtb), remains one of the deadliest infectious diseases in the world, and the co-infections of tuberculosis with COVID-19 and HIV have become a matter of global concern ( 1 , 2 ). The Mtb is a well-equipped pathogen that poses a significant risk to human health, as it possesses inherent capabilities to adapt and reside within the phagosomes of human macrophage, persisting for several years, or even decades within specific granulomas ( 3 ).…”