Series 3: From Infection to Disease: A Global Scoping Review of Medical and Behavioural Determinants of Progression from TB Infection to TB Disease

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Résumé

Background: Tuberculosis (TB) remains a major global health threat, particularly in lowand
middle-income countries, with TB infection (TBI) serving as the primary source of
TB disease. While HIV infection has long been recognised as a major risk factor for TB
progression, the rise of Non-Communicable Diseases (NCDs), which may exert immunosuppressive
effects, further compounded by their treatment, contributes to increased TB
susceptibility. This scoping review synthesises evidence from systematic reviews on medical
and behavioural risk factors for TBI progression to TB disease, for both asymptomatic
and symptomatic disease. Methods: A preliminary literature search was conducted on
11 January 2025, in PUBMED using the keywords “tuberculosis,” “asymptomatic
or subclinical tuberculosis” “risk factors,” and “systematic review” followed by targeted
reviews on the identified medical and behavioural risk factors for TB infection
progression to TB disease. Results: A total of 25 systematic reviews were included.
Medical risk factors for progression from TB infection to TB disease included
diabetes mellitus (DM), chronic kidney disease (CKD), chronic obstructive pulmonary
disease (COPD), undernutrition (including iron and vitamin D deficiency),
cancer—particularly haematological malignancies—and immunosuppressive therapies
(TNF-α inhibitors and glucocorticoids). Iron and vitamin D deficiency, particularly
severe deficiency, is linked to increased TB risk, especially among people living
with HIV. Behavioural risk factors, including tobacco, drug, and alcohol use, were
also highlighted. Geographic variations in TB prevalence, diagnostic practices, and
healthcare systems contributed to differences in risk estimates across reviews. No systematic reviews were identified that examined risk factors for asymptomatic TB.
Conclusions: The convergence of TB with NCDs, compounded by immunosuppressive
therapies, poses a public health challenge in high TB burden settings. Effective
TB prevention requires targeted screening, along with enhanced management of these
NCDs. Nutritional support, particularly screening and treatment of anaemia and vitamin
D deficiency, may benefit individuals with TBI, comorbid NCDs, and HIV. A
multidisciplinary approach, integrating behavioural interventions and tailored prevention
strategies, is essential to achieving WHO’s End TB targets. Addressing the evidence
gap on risk factors for asymptomatic TB is also critical to improve early detection and
interrupt transmission.

Mots-clés

tuberculosis disease; medical risk factors; behavioural risk factors