Post-tuberculosis lung disease in people with HIV: a scoping and narrative review

Tuberculosis (TB) is the leading cause of illness in people with HIV (PWH), with many survivors experiencing lasting lung damage. Post-TB lung disease (PTLD) is a challenge in this group, where additional respiratory insults, poor nutrition and healthcare access barriers may compound disability. In this scoping review, we explore the burden and patterns PTLD in PWH versus HIV-negative individuals through meta-analysis and narrative synthesis, and describe mechanisms of HIV-associated PTLD with emerging prevention, care strategies, and research priorities.

HIV infection was associated with lower or equivalent PTLD burden across most spirometry, radiology and functional outcomes; however, despite higher rates of pulmonary TB in PWH, studies directly comparing PTLD in PWH versus HIV-negative individuals are few. Sub-analyses, including role of antiretroviral therapy, CD4 count and recurrent TB, were limited by data availability. Neutrophil-driven matrix metalloproteinase activity, cytokine dysregulation, and immune reconstitution is implicated in HIV-associated lung damage; host-directed therapies with potential for attenuating PTLD are under evaluation, though representation of PWH is limited. Gaps persist in integrating PTLD care into HIV-TB services, and longitudinal data are needed to define recovery trajectories and inform strategies for prevention and management.

PTLD in PWH shows variable burden and requires multidisciplinary integrated care. Inflammatory mechanisms and care gaps underscore the need for targeted research.