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Nutritional acquired immunodeficiency (N-AIDS) a key driver of TB Pandemic

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Tuberculosis (TB) is the leading infectious killer worldwide, with 10.6 million cases and 1.6 million deaths in 2021 alone. One in five incident TB cases were attributable to malnutrition, more than double the number attributed to HIV/AIDS. Like HIV/AIDS, malnutrition is a cause of secondary immunodeficiency, known as nutritionally acquired immunodeficiency syndrome (N-AIDS). However, N-AIDS remains the neglected cousin of HIV/AIDS in global TB elimination efforts.

The International Union Against Tuberculosis and Lung Disease (The Union), in collaboration with researchers at Boston University, Cornell University, University of Virginia and Jawaharlal Institute of Postgraduate Medical Education and Research, reviewed decades of data and make the case that N-AIDS, just like HIV/AIDS, deserves special consideration in the effort to eliminate TB.

The study team also argue that leveraging nutritional interventions can help to detect, prevent, and treat TB more effectively.

“While there have been important technological advancements to detect and treat TB, our interpretation of the existing literature is that we won’t be able to make substantive changes in TB incidence and mortality rates without action on malnutrition,” explains co-author Pranay Sinha, Lead of The Union’s TB Undernutrition working group.

After reading more than 75 papers on nutrition and TB, the researchers briefly recount the impact that actions on HIV had on the global TB pandemic. They point out that malnutrition is a leading cause of immunodeficiency worldwide. “People with severe malnutrition, like people with HIV, are at increased risk of TB. We can leverage what we already know about malnutrition to aid us in detecting, treating and preventing TB,” says Sinha, Assistant Professor of Medicine at Boston University.

While the researchers believe it is urgent to continue to develop newer tools, approaches should not be limited to biomedical interventions. For example, a study included in their review found that TB incidence among household contacts of people with TB was reduced by 40% by providing them with an inexpensive food basket.

“It is important to understand that TB is not simply a medical disease, it’s a social one and our elimination efforts must recognise that,” says Dr Kobto Koura, co-author and Director of TB at The Union.

“Fortunately, malnutrition is an adjustable risk factor and through this review we have highlighted the evidence that addressing nutrition can help us curb the TB pandemic,” he adds.

The researchers believe this paper will help advocates, clinicians, policymakers and the public think differently about the management of persons with TB as well as the needed global health investments to eradicate it.

The paper was published in BMC Global & Public Health.