Analysis of tuberculosis and multiple diseases as co-morbidities: a narrative review

Tuberculosis (TB) remains the leading cause of death from infectious diseases worldwide, and its control is increasingly complicated by chronic comorbidities. Diabetes mellitus (DM), human immunodeficiency virus (HIV) infection, chronic obstructive pulmonary disease (COPD), and lung cancer (LC) substantially affect TB susceptibility, diagnosis, treatment, and prognosis.

This narrative review summarizes evidence on the interactions between TB and DM, HIV infection, COPD, and LC. Relevant literature was identified through PubMed, Web of Science, and World Health Organization publications, focusing on studies published between 2001 and 2025. Priority was given to peer-reviewed original studies and reviews addressing immune mechanisms, diagnosis, and treatment.

DM increases TB risk by impairing innate and adaptive immunity and complicates prevention, diagnosis, and treatment. HIV-1 weakens antimycobacterial defense through lymphocyte depletion, macrophage dysfunction, granuloma instability, and immune exhaustion, markedly increasing susceptibility to active TB. TB and COPD mutually aggravate pulmonary inflammation, oxidative stress, and structural lung damage, contributing to poor respiratory outcomes. Mycobacterium tuberculosis(M.tb) infection may also be associated with LC development through chronic inflammation, oxidative stress-related genomic instability, and oncogenic signaling. Overall, these comorbidities increase diagnostic difficulty, therapeutic complexity, and the risk of adverse outcomes.

TB associated comorbidities remain a major challenge to global TB control. Understanding these interactions may support bidirectional screening, risk stratification, and integrated management. Although these conditions share immune dysregulation, chronic inflammation, and oxidative stress, they differ in dominant mechanisms, diagnostic challenges, and treatment priorities. Future research should prioritize biomarker discovery, mechanistic clarification, and multilevel prevention and control strategies.