Post-tuberculosis morbidities and their associated mortality: moving from challenges to solutions

The case fatality of tuberculosis (TB) has progressively decreased since the use of antibiotics in anti-TB treatment, leaving 155 million TB survivors alive in 2020. Of the 122 million disability-adjusted life years (DALYs) due to TB in 2019, 58 million DALYs were attributed to the post-TB phase. TB causes massive lung structure damage, declined lung function and excessive inflammation, which persist even after microbiological cure and predispose to multiple lung diseases (e.g. COPD, chronic pulmonary aspergillosis, bronchiectasis and COVID-19). TB survivors also face a higher risk of cancers and cardiovascular diseases. These post-TB morbidities together with worse psychological and socioeconomic status lead to poor quality of life and a three- to four-fold higher mortality rate than the general population. Understanding the epidemiology of post-TB morbidities can help to set intervention and research priorities to lower public health burdens associated with post-TB morbidities. In this narrative review, we summarise what we know and do not know about the prevalence, risk factors and management of post-TB morbidities and their associated mortality. We identify the major post-TB morbidities based on current evidence. Delayed or incomplete TB treatment, residual lung structure damage and prolonged inflammation after TB treatment are important risk factors. Developing host-directed therapies to reduce lung structure damage, smoking cessation, implementing pulmonary rehabilitation to improve lung function and adopting well-tailored preventive strategies and screening protocols may improve the management of these post-TB morbidities and mortality and warrant future research.