Alcohol Use Impacts on Tuberculosis Treatment and Outcomes

Alcohol consumption represents both a social and biological modulator of tuberculosis (TB) risk, treatment efficacy and long-term outcomes. Heavy or disordered drinking compromises lung immunity by impairing the function of alveolar macrophages, disrupting cytokine networks and increasing oxidative stress in the respiratory tract, thereby facilitating Mycobacterium tuberculosis infection and progression to active disease. Social determinants linked to problematic alcohol use—such as poverty, malnutrition and social marginalisation—further elevate TB incidence and impede timely care seeking. During therapy, alcohol misuse contributes to pharmacokinetic alterations of first-line anti-TB drugs and to poor adherence, with higher rates of treatment failure, relapse, drug resistance and loss to follow-up. Stigma and resource constraints often hinder the provision of integrated alcohol-reduction interventions within TB services. Efforts to meet global TB elimination targets must therefore address alcohol use through universal screening, brief behavioural interventions, community-based support and host-directed therapies that restore lung immunity. Such dual-disease strategies promise to improve culture conversion rates, reduce mortality and promote sustainable recovery for people with TB who consume alcohol.

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Alcohol Use Impacts on Tuberculosis Treatment and Outcomes publication trend

The graph below shows the total number of articles in alcohol use impacts on tuberculosis treatment and outcomes across all publications each year (not limited to Nature Index journals).

Technical terms

Alcohol Use Disorder (AUD): A clinical condition characterised by impaired control over drinking, leading to harmful physical, social or psychological consequences.

Alveolar Macrophage: A key innate immune cell in the lung that engulf and destroy inhaled pathogens, including Mycobacterium tuberculosis.

Culture Conversion: The point during TB treatment when patient sputum samples no longer yield viable M. tuberculosis in culture, indicating effective therapy.

Non-adherence: Failure to follow prescribed TB treatment regimens, often resulting in treatment failure, relapse or drug resistance.

Pharmacokinetics: The study of how the body absorbs, distributes, metabolises and excretes medications, which can be altered by alcohol consumption.

References

1. Global, regional, and national mortality of tuberculosis attributable to alcohol and tobacco from 1990 to 2019: A modelling study based on the Global Burden of Disease study 2019. Journal of Global Health (2024).
2. Patient and provider perceptions of the relationship between alcohol use and TB and readiness for treatment: a qualitative study in South Africa. BMC Public Health (2024).
3. The Impact of Alcohol Use Disorder on Tuberculosis: A Review of the Epidemiology and Potential Immunologic Mechanisms. Frontiers in Immunology (2022).
4. The impact of alcohol use on tuberculosis treatment outcomes: a systematic review and meta-analysis. The International Journal of Tuberculosis and Lung Disease (2020).