ArticleThe Lancet. Global health2023
Quantifying progression and regression across the spectrum of pulmonary tuberculosis: a data synthesis study.
Article in The Lancet. Global health, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 51 papers, 1 of them a synthesis that pooled it.
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Who cites it
51 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Subclinical tuberculosis: a meta-analysis of prevalence and scoping review of definitions, prevalence and clinical characteristics.European respiratory review : an official journal of the European Respiratory Society · 2024Pooled it
- Tuberculosis Disease Severity Assessment Using Clinical Variables and Radiology Enabled by Artificial Intelligence.The Journal of infectious diseases · 2026Article
- Longitudinal Symptom Transitions Predict Incident Tuberculosis Risk in Serial Active Case Finding.The Journal of infectious diseases · 2026Article
- Centralized molecular testing of community-collected tongue swabs for tuberculosis screening among household contacts: a cross-sectional diagnostic performance, yield, and implementation study.medRxiv : the preprint server for health sciences · 2026Article
- A model for the epidemiological impact of tuberculosis policy options.Bulletin of the World Health Organization · 2026Article
- Cost-effectiveness of community tuberculosis screening in South Africa.American journal of respiratory and critical care medicine · 2026Article
- Refining cytokine signatures: flow cytometry-based differentiation between TB infection and disease.IJTLD open · 2026Article
- PET-CT benchmarked detection and 5-year progression of asymptomatic tuberculosis: a longitudinal, prospective cohort study.The Lancet. Respiratory medicine · 2026Article
- Elimination of senescent cells with senolytic drugs as adjunctive host-directed therapy reduces tuberculosis progression in mice.Nature communications · 2026Article
- Potential long-acting tuberculosis treatment for people with HIV: cost-effectiveness benchmarks.Annals of the American Thoracic Society · 2026Article
- Performance of Human and Computer-aided Evaluation of Digital Chest Radiography for Community-based Screening of Asymptomatic Tuberculosis.medRxiv : the preprint server for health sciences · 2026Article
- Cost-effectiveness of latent tuberculosis infection testing and preventive treatment among TB contacts in China: a Markov model.BMC health services research · 2026Article
- Trade-offs in diagnostic algorithm, population coverage, and duration of community screening for tuberculosis: A modelling study.PLoS medicine · 2026Article
- Modelling the impact of increasing tuberculosis treatment coverage and addressing determinants of risk in men.Communications medicine · 2026Article
- Diagnostic value of phenotypic testing combined with molecular biology testing for tuberculosis.Scientific reports · 2026Article
- The hidden burden: a regional study revealing the substantial burden and distinct epidemiology of asymptomatic pulmonary tuberculosis in Southern China.BMC public health · 2026Article
- Reappraising TB preventive treatment in India: programmatic and ethical implications of subclinical tuberculosis in household contacts.The Lancet regional health. Southeast Asia · 2026Review
- Estimating the population impact of new tuberculosis vaccines depending on efficacy against infectious asymptomatic tuberculosis: A modelling study.PLoS medicine · 2026Article
- Long-term risk of tuberculosis among individuals with Xpert Ultra trace screening results in Uganda: a longitudinal follow-up study.The Lancet. Infectious diseases · 2026Article
- Factors associated with tuberculosis symptom reporting among persons deprived of liberty in Brazil during active case finding: a cross-sectional study.BMJ public health · 2026Article
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16 authors.
Funding
Abstract
backgroundPrevalence surveys show a substantial burden of subclinical (asymptomatic but infectious) tuberculosis, from which individuals can progress, regress, or even persist in a chronic disease state. We aimed to quantify these pathways across the spectrum of tuberculosis disease.
methodsWe created a deterministic framework of untreated tuberculosis disease with progression and regression between three states of pulmonary tuberculosis disease: minimal (non-infectious), subclinical (asymptomatic but infectious), and clinical (symptomatic and infectious). We obtained data from a previous systematic review of prospective and retrospective studies that followed and recorded the disease state of individuals with tuberculosis in a cohort without treatment. These data were considered in a Bayesian framework, enabling quantitative estimation of tuberculosis disease pathways with rates of transition between states and 95% uncertainty intervals (UIs).
findingsWe included 22 studies with data from 5942 individuals in our analysis. Our model showed that after 5 years, 40% (95% UI 31·3-48·0) of individuals with prevalent subclinical disease at baseline recover and 18% (13·3-24·0) die from tuberculosis, with 14% (9·9-19·2) still having infectious disease, and the remainder with minimal disease at risk of re-progression. Over 5 years, 50% (40·0-59·1) of individuals with subclinical disease at baseline never develop symptoms. For those with clinical disease at baseline, 46% (38·3-52·2) die and 20% (15·2-25·8) recover from tuberculosis, with the remainder being in or transitioning between the three disease states after 5 years. We estimated the 10-year mortality of people with untreated prevalent infectious tuberculosis to be 37% (30·5-45·4).
interpretationFor people with subclinical tuberculosis, classic clinical disease is neither an inevitable nor an irreversible outcome. As such, reliance on symptom-based screening means a large proportion of people with infectious disease might never be detected.
fundingTB Modelling and Analysis Consortium and European Research Council.
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