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This worrying situation is aggravated by coinfection with human immunodeficiency virus (HIV), and by the increase in drug-resistant strains.<\/jats:p><jats:p>We need new insights that lead to more rapid therapies and immunotherapies, and more reliable vaccines.<\/jats:p><jats:p>Recent insights have come from: understanding of the relationship between<jats:italic>Mycobacterium tuberculosis<\/jats:italic>and macrophages; the multiple T cell types that recognise mycobacterial peptides, lipids and glycolipids; the critical role of interferon\u2010\u03b3 (IFN\u03b3) and interleukin\u201012 (IL\u201012) in human mycobacterial infection revealed by genetically defective children; quantitation of the presence and importance of Th2 lymphocyte activation in human tuberculosis; the role of local conversion of inactive cortisone to active cortisol in the lesions; the recognition that some effective prophylactic vaccines also work as immumotherapeutics whereas others do not. 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