For centuries the treatment of TB has presented an enormous challenge to global health. In the 20th century, the treatment of TB patients with long-term multidrug
therapy gave hope that TB could be controlled and cured; however, contrary to these expectations and coinciding with the emergence of
AIDS, the world has witnessed a rampant increase in hard-to-treat cases of TB, along with the emergence of highly virulent and multidrug-resistant Mycobacterium tuberculosis strains. Unfortunately, these bacteria are now circulating around the world, and there are few effective drugs to treat them. As a result, the prospects for improved treatment and control of TB in the 21st century have worsened and we urgently need to identify new
therapies that deal with this problem. The potential use of
immunotherapy for TB is now of greater consideration than ever before, as
immunotherapy could potentially overcome the problem of drug resistance. TB
immunotherapy targets the already existing host anti-TB immune response and aims to enhance killing of the bacilli. For this purpose, several approaches have been used: the use of anti-Mycobacteria
antibodies; enhancing the Th1 protective responses by using mycobacterial
antigens or increasing Th1
cytokines; interfering with the inflammatory process and targeting of immunosuppressive pathways and targeting the cell activation/proliferation pathways. This article reviews our current understanding of TB immunity and targets for
immunotherapy that could be used in combination with current TB
chemotherapy.