{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T05:18:17Z","timestamp":1788499097898,"version":"build-2803163510"},"reference-count":41,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:00:00Z","timestamp":1788307200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"crossref","award":["2R15HL143545-02"],"award-info":[{"award-number":["2R15HL143545-02"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"award":["2R15HL143545-02"],"award-info":[{"award-number":["2R15HL143545-02"]}],"id":[{"id":"https:\/\/ror.org\/01cwqze88","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Tuberculosis (TB) is a leading global cause of infectious disease. Growing evidence suggests that TB significantly increases the risk of comorbidity in HIV+ patients, particularly acute ischemic stroke (AIS). Prognosis is often poor, highlighting the need for early prevention and intervention. However, exact mechanisms linking HIV-Mtb coinfection and stroke remain poorly understood. A review of articles from 2016 to 2026 was conducted to study the risk of ischemic stroke and treatment strategies in HIV-Mtb coinfection. Both HIV and Mtb can increase stroke risk, but pathogenesis of the coinfection and relationship between the coinfection and stroke remain as proposals. Antiretroviral therapy (ART) has shown variable success rates; it may increase the risk of stroke or be associated with worse outcomes. Multi-drug-resistant TB (MDR-TB) can be treated with a combination of bedaquiline, linezolid, and pretomanid (BPaL). Steroids and vitamin D supplementation with ART are associated with improved outcomes. For coinfection screening, the monocyte-to-lymphocyte ratio (MLR) and a clinical scoring system for triage may prove useful for early detection, leading to prompt intervention. A clearer understanding of the association between HIV-Mtb coinfection and stroke is essential for developing effective prevention strategies and eliminating transmission. Advancement of current treatments will help improve long-term outcomes in HIV-Mtb coinfection.<\/jats:p>","DOI":"10.3390\/v18090965","type":"journal-article","created":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T10:57:23Z","timestamp":1788346643000},"page":"965","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Literature Review on HIV-Mtb Coinfection and Stroke Risk"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7857-8000","authenticated-orcid":false,"given":"Jiwon","family":"Han","sequence":"first","affiliation":[{"name":"College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Apeksha","family":"Kamat","sequence":"additional","affiliation":[{"name":"College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmin","family":"Nguyen","sequence":"additional","affiliation":[{"name":"College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phat","family":"Nguyen","sequence":"additional","affiliation":[{"name":"College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1439-0350","authenticated-orcid":false,"given":"Katelyn","family":"Vu","sequence":"additional","affiliation":[{"name":"College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa","family":"Zhao","sequence":"additional","affiliation":[{"name":"College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2586-1160","authenticated-orcid":false,"given":"Vishwanath","family":"Venketaraman","sequence":"additional","affiliation":[{"name":"College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,2]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1016\/j.ijtb.2020.02.005","article-title":"A systemic review on tuberculosis","volume":"67","author":"Natarajan","year":"2020","journal-title":"Indian J. Tuberc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"47","DOI":"10.4046\/trd.2015.78.2.47","article-title":"Diagnosis and treatment of extrapulmonary tuberculosis","volume":"78","author":"Lee","year":"2015","journal-title":"Tuberc. Respir. Dis."},{"key":"ref_3","unstructured":"World Health Organization (2025). Global Tuberculosis Report 2025, World Health Organization."},{"key":"ref_4","unstructured":"Centers for Disease Control and Prevention (2026, June 12). About HIV, Available online: https:\/\/www.cdc.gov\/hiv\/about\/index.html."},{"key":"ref_5","unstructured":"World Health Organization (2026, June 12). HIV Data and Statistics. Available online: https:\/\/www.who.int\/teams\/global-hiv-hepatitis-and-stis-programmes\/hiv\/strategic-information."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"106034","DOI":"10.1016\/j.puhe.2025.106034","article-title":"Global prevalence of HIV and Mycobacterium tuberculosis co-infection: A systematic review and meta-analysis of 371 included articles","volume":"249","author":"Wu","year":"2025","journal-title":"Public Health"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1009","DOI":"10.1001\/archinte.163.9.1009","article-title":"The growing burden of tuberculosis: Global trends and interactions with the HIV epidemic","volume":"163","author":"Corbett","year":"2003","journal-title":"Arch. Intern. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1056\/NEJMoa0907488","article-title":"An algorithm for tuberculosis screening and diagnosis in people with HIV","volume":"362","author":"Cain","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_9","unstructured":"World Health Organization (2016). Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach, World Health Organization. [2nd ed.]. Available online: https:\/\/www.who.int\/publications\/i\/item\/9789241549684."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1588","DOI":"10.1016\/S0140-6736(11)60204-3","article-title":"6-month versus 36-month isoniazid preventive treatment for tuberculosis in adults with HIV infection in Botswana: A randomised, double-blind, placebo-controlled trial","volume":"377","author":"Samandari","year":"2011","journal-title":"Lancet"},{"key":"ref_11","unstructured":"World Health Organization (2006). WHO STEPS Stroke Manual: The WHO STEPwise Approach to Stroke Surveillance, World Health Organization."},{"key":"ref_12","unstructured":"(2024). GBD 2021 Stroke Risk Factor Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2021: A systematic analysis for the Global Burden of Disease Study 2021. Lancet Neurol., 23, 973\u20131003."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"4915","DOI":"10.1002\/jmv.27010","article-title":"Stroke and HIV-associated neurological complications: A retrospective nationwide study","volume":"93","author":"Patel","year":"2021","journal-title":"J. Med. Virol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1212\/01.wnl.0000259515.45579.1e","article-title":"Mechanisms of ischemic stroke in HIV-infected patients","volume":"68","author":"Ortiz","year":"2007","journal-title":"Neurology"},{"key":"ref_15","first-page":"52","article-title":"Clinical manifestations of pulmonary and extra-pulmonary tuberculosis","volume":"6","author":"Wani","year":"2013","journal-title":"South Sudan Med. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"28","DOI":"10.22442\/jlumhs.191810597","article-title":"Outcome of Tuberculous Meningitis in Adults","volume":"18","author":"Haji","year":"2019","journal-title":"J. Liaquat Univ. Med. Health Sci."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Dodd, P.J., Osman, M., Cresswell, F.V., Stadelman, A.M., Lan, N.H., Thuong, N.T.T., Muzyamba, M., Glaser, L., Dlamini, S.S., and Seddon, J.A. (2021). The global burden of tuberculous meningitis in adults: A modelling study. PLoS Glob. Public Health, 1.","DOI":"10.1371\/journal.pgph.0000069"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1177\/17474930241308142","article-title":"World Stroke Organization: Global Stroke Fact Sheet 2025","volume":"20","author":"Feigin","year":"2025","journal-title":"Int. J. Stroke"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1038\/nrmicro.2017.128","article-title":"Pathogenesis of HIV-1 and Mycobacterium tuberculosis co-infection","volume":"16","author":"Bell","year":"2018","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e30405","DOI":"10.1097\/MD.0000000000030405","article-title":"Diagnosis and treatment of tuberculosis in adults with HIV","volume":"101","author":"Yang","year":"2022","journal-title":"Medicine"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"3401","DOI":"10.1161\/STROKEAHA.122.039484","article-title":"Tuberculosis and Risk of Ischemic Stroke: A Nationwide Cohort Study","volume":"53","author":"Lee","year":"2022","journal-title":"Stroke"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1159\/000544986","article-title":"Stroke from Infection","volume":"15","author":"Chutinet","year":"2025","journal-title":"Cerebrovasc. Dis. Extra"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e087218","DOI":"10.1136\/bmjopen-2024-087218","article-title":"Impact of HIV coinfection on tuberculosis treatment outcomes in Ethiopia: A systematic review and meta-analysis","volume":"14","author":"Mekonen","year":"2024","journal-title":"BMJ Open"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1915","DOI":"10.1056\/NEJMoa1800762","article-title":"Prednisone for the Prevention of Paradoxical Tuberculosis-Associated IRIS","volume":"379","author":"Meintjes","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1186\/s12981-025-00799-5","article-title":"The association of antiretroviral therapy type and duration of use with stroke in people living with HIV in Zambia","volume":"22","author":"Zimba","year":"2025","journal-title":"AIDS Res. Ther."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"fmac066","DOI":"10.1093\/tropej\/fmac066","article-title":"Effect of Vitamin D Supplementation on CD4 Count in HIV-Infected Children and Adolescents in North India: A Non-Randomized Comparative Study","volume":"68","author":"Verma","year":"2022","journal-title":"J. Trop. Pediatr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1097\/QAI.0000000000001893","article-title":"Monocyte-to-Lymphocyte Ratio Is Associated with Tuberculosis Disease and Declines with Anti-TB Treatment in HIV-Infected Children","volume":"80","author":"Choudhary","year":"2019","journal-title":"J. Acquir. Immune Defic. Syndr."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Hanifa, Y., Fielding, K.L., Chihota, V.N., Adonis, L., Charalambous, S., Foster, N., Karstaedt, A., McCarthy, K., Nicol, M.P., and Ndlovu, N.T. (2017). A clinical scoring system to prioritise investigation for tuberculosis among adults attending HIV clinics in South Africa. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0181519"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Bell, L.C., Pollara, G., Pascoe, M., Tomlinson, G.S., Lehloenya, R.J., Roe, J., Meldau, R., Miller, R.F., Ramsay, A., and Chain, B.M. (2016). In Vivo Molecular Dissection of the Effects of HIV-1 in Active Tuberculosis. PLoS Pathog., 12.","DOI":"10.1371\/journal.ppat.1005469"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1262","DOI":"10.1164\/rccm.200907-1011OC","article-title":"HIV-1 infection impairs the bronchoalveolar T-cell response to mycobacteria","volume":"180","author":"Kalsdorf","year":"2009","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"4022","DOI":"10.1128\/IAI.00106-10","article-title":"Effects of in vitro HIV-1 infection on mycobacterial growth in peripheral blood monocyte-derived macrophages","volume":"78","author":"Pathak","year":"2010","journal-title":"Infect. Immun."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"4226","DOI":"10.1182\/blood-2009-12-259473","article-title":"Inhibition of phagocytosis in HIV-1-infected macrophages relies on Nef-dependent alteration of focal delivery of recycling compartments","volume":"115","author":"Mazzolini","year":"2010","journal-title":"Blood"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"106274","DOI":"10.1016\/j.jstrokecerebrovasdis.2021.106274","article-title":"Infectious Causes of Stroke","volume":"31","author":"Murala","year":"2022","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/S1473-3099(13)70692-3","article-title":"Effects of early versus delayed initiation of antiretroviral treatment on clinical outcomes of HIV-1 infection: Results from the phase 3 HPTN 052 randomised controlled trial","volume":"14","author":"Grinsztejn","year":"2014","journal-title":"Lancet Infect. Dis."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e77","DOI":"10.1016\/S1473-3099(18)30537-1","article-title":"Transmission of drug-resistant tuberculosis in HIV-endemic settings","volume":"19","author":"Khan","year":"2019","journal-title":"Lancet Infect. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1056\/NEJMoa1901814","article-title":"Treatment of Highly Drug-Resistant Pulmonary Tuberculosis","volume":"382","author":"Conradie","year":"2020","journal-title":"N. Engl. J. Med."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Campbell, G.R., and Spector, S.A. (2012). Vitamin D inhibits human immunodeficiency virus type 1 and Mycobacterium tuberculosis infection in macrophages through the induction of autophagy. PLoS Pathog., 8.","DOI":"10.1371\/journal.ppat.1002689"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1007\/s15010-001-1198-3","article-title":"Clinical, cerebrospinal fluid and pathological findings and outcomes in HIV-positive and HIV-negative patients with tuberculous meningitis","volume":"29","author":"Schutte","year":"2001","journal-title":"Infection"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"e2013017","DOI":"10.4084\/mjhid.2013.017","article-title":"Stroke in a Patient with Tuberculous Meningitis and HIV Infection","volume":"5","author":"Pasticci","year":"2013","journal-title":"Mediterr. J. Hematol. Infect. Dis."},{"key":"ref_40","unstructured":"World Health Organization (2022). WHO Consolidated Guidelines on Tuberculosis. Module 4: Treatment\u2014Drug-Resistant Tuberculosis Treatment, 2022 Update, World Health Organization."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Clouse, K., Blevins, M., Lindegren, M.L., Yotebieng, M., Nguyen, D.T., Omondi, A., Michael, D., Zannou, D.M., Carriquiry, G., and Pettit, A. (2017). Low implementation of Xpert MTB\/RIF among HIV\/TB co-infected adults in the International epidemiologic Databases to Evaluate AIDS (IeDEA) program. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0171384"}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/18\/9\/965\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T04:46:28Z","timestamp":1788497188000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/18\/9\/965"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,2]]},"references-count":41,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["v18090965"],"URL":"https:\/\/doi.org\/10.3390\/v18090965","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,2]]}}}