Tuberculosis (TB) remains a major threat to global health, especially in low- and middle-income countries [1,2]. Intensified efforts in diagnosis, treatment, and public health interventions have led to declining mortality rates and improved cure rates for TB. However, these advancements have also resulted in a growing number of individuals who survive TB treatment, emphasizing the need for management strategies that extend beyond early case detection and treatment completion. As these survivors transition out of acute care, it is increasingly recognized that completing anti-TB treatment does not necessarily mean full recovery or the restoration of pre-disease health. Evidence shows that many TB survivors experience persistent symptoms, functional limitations, and long-term complications, underscoring the necessity to broaden the clinical and policy focus to include aspects beyond microbiologic cure.

Most post-TB care has focused on pulmonary sequelae, such as bronchiectasis and chronic lung function impairment. However, recent studies have shown that TB can have extensive effects on multiple organ systems, including cardiovascular, neurological, musculoskeletal, metabolic, and psychosocial domains [3-6]. Moreover, the impact on quality of life, mental health, and socioeconomic wellbeing can be profound and lasting. In light of these findings, there is an urgent need to reframe TB outcomes more holistically. This review aims to provide a comprehensive overview of ‘post-TB’ disease, encompassing not only pulmonary outcomes but also multisystemic sequelae and the broader concept of post-TB health and wellbeing. Given the lack of data on children and adolescents [7], this review will focus on post-TB sequelae in adult populations.

TB has long been regarded as a curable infectious disease that primarily affects the lungs in many parts of the world [1]. Increasing evidence indicates that many TB survivors experience ongoing or emerging health issues, which include not only structural lung damage but also impairment of extrapulmonary organs, mental health challenges, functional limitations, and a reduced quality of life. Recent estimates suggest that post-TB sequelae account for nearly half of the total TB-related disability-adjusted life years globally, highlighting a significant and previously under-recognized burden on survivors and health systems [8].

Despite the increasing recognition of the health impacts following TB, there is currently no single universally accepted term that fully encompasses the breadth of the post-TB experience. Instead, a variety of overlapping terminologies are employed in clinical practice, public health, and academic literature to describe different facets of post-TB health. Each term reflects a specific perspective, ranging from clinical diagnosis to policy framing to functional disability, and highlights distinct aspects of the post-TB burden.

To clarify the scope and usage of these terms, Table 1 provides a comparative overview of commonly used expressions, such as ‘post-TB disease [9],’ ‘sequelae [10],’ ‘morbidity [11],’ ‘disability [12],’ and ‘health [13],’ based on their definitions, included elements, and appropriate contexts. Previous terms such as ‘post-TB sequelae,’ ‘post-TB morbidity,’ and ‘post-TB health’ have been used inconsistently. ‘Post-TB sequelae’ generally implies irreversible structural damage or static residual lesions, primarily confined to the lungs. ‘Post-TB morbidity’ focuses on the burden and disability associated with TB but does not indicate an ongoing pathological process. ‘Post-TB health’ emphasizes holistic wellbeing after TB but lacks specificity regarding pathological conditions. The concept of ‘post-TB health’ advocates for a people-centered, holistic approach, acknowledging the physical, psychological, and social needs of TB survivors beyond mere microbiological cure [13]. These terms do not adequately reflect that many individuals experience dynamic, multisystem, and sometimes progressive disease processes following TB, which extend beyond residual scarring or disability. This variation in terminology underscores the heterogeneity of post-TB manifestations and emphasizes the need for a more integrated conceptual framework to inform clinical care, health systems planning, and survivor-centered policy development. Given the wide range of health outcomes experienced by TB survivors, there is an increasing need to define ‘post-TB disease’ in a manner that accurately reflects both clinical and functional realities. Drawing from recent efforts to characterize post-infectious conditions, such as long coronavirus disease (COVID) [14], and considering the limitations of existing TB-specific terminology, we can propose the following definition (Table 2).

Post-TB disease is a chronic condition associated with TB that can arise after TB infection or its treatment. It is characterized by ongoing or re-emerging pathological activity rather than mere static damage and may impact one or more organ systems. Importantly, it includes both symptomatic individuals and those with asymptomatic structural or functional sequelae. This condition reflects the long-term consequences of TB—structural, functional, psychological, or social—and can impair health-related quality of life and overall wellbeing.

This proposed definition acknowledges the diversity of post-TB manifestations, the potential for delayed onset, and their impact on both diagnosed disease and lived experiences. It shifts away from a narrow focus on pulmonary sequelae and supports a multidimensional framework that integrates clinical care, rehabilitation, and survivor support. Post-TB disease emphasizes a broader and more dynamic concept, reframing post-TB outcomes as an active disease continuum rather than a static endpoint of prior infection.

Increasing evidence demonstrates that TB can lead to persistent structural, functional, and immunologic changes across multiple organ systems (Figure 1). These multisystem sequelae may arise from the infection itself, its inflammatory aftermath, treatment-related toxicity, or secondary deconditioning. Recognizing these extrapulmonary consequences is essential for comprehensive post-TB care and underscores the need for a holistic approach to TB survivorship.

Many TB survivors face ongoing challenges that impact their health-related quality of life and overall wellbeing, even when there are no apparent clinical abnormalities. These difficulties are often multidimensional, involving psychological distress, social disruption, and economic vulnerability, and they may persist long after TB treatment has concluded.

Psychological wellbeing is often compromised by the traumatic experience of TB, prolonged treatment, stigma, and fear of recurrence. Depression and anxiety are common, particularly among patients who have experienced hospitalization, isolation, or complications such as drug resistance [40,41]. These mental health effects may be worsened by internalized stigma and a lack of social support. Importantly, many TB survivors continue to suffer in silence because mental health care is often inaccessible or culturally stigmatized in high-burden settings.

Social wellbeing is significantly impacted by TB, a disease that carries a high level of stigma in many societies. Even after achieving microbiological cure, survivors often continue to face social repercussions. TB can result in extended withdrawal from work, school, and community life. In certain cultural contexts, survivors encounter ongoing stigma, rejection in marriage or employment, and a loss of social status. These challenges can exacerbate the existing stigma, further undermining self-esteem and identity, and leading to enduring feelings of marginalization and disconnection from society.

Economic wellbeing is frequently compromised by TB. Even when treatment is offered at no cost, indirect expenses—such as transportation, lost wages, and caretaking duties—can be significant. TB predominantly affects individuals of working age in many regions, often the primary earners in their households. Consequently, the financial repercussions of TB can impact entire families. Many TB survivors return to work with diminished physical capacity, encounter discrimination during hiring, or remain unemployed for long periods. For those in informal or unstable jobs, TB can trigger or worsen a cycle of poverty that may last for years or even generations.

To address these hidden yet profound effects of TB, a holistic approach to post-TB care is essential. Wellbeing should be regarded as a primary outcome rather than a secondary concern. In addition to achieving medical recovery, TB programs and health systems must focus on restoring dignity, functionality, and full participation in society for all TB survivors. While many existing initiatives have concentrated primarily on PTLD, there is a pressing need for more comprehensive frameworks that consider multisystem sequelae and the wider social and economic aspects of recovery. This will necessitate integrated policies, intersectoral collaboration, and the active participation of affected communities in designing and assessing post-TB support systems.

Given the multisystem nature of post-TB disease, a comprehensive and structured assessment is essential to identify residual morbidity, inform individualized care, and guide long-term follow-up (Figure 2). Many post-TB sequelae, such as exercise intolerance, fatigue, and neurocognitive impairment, are often under-recognized because they go undetected unless clinicians actively screen for them or specifically inquire during follow-up.

A minimum baseline evaluation conducted near the end of antimicrobial treatment for TB has been suggested as a useful reference point [42]. From this baseline, tailored follow-up can be planned. For PTLD, the initial assessment includes symptom screening (dyspnea, cough, hemoptysis), vital signs (respiratory rate, oxygen saturation), spirometry (pre- and post-bronchodilator), and lung imaging (chest X-ray or computed tomography scan) (Table 3). Exercise capacity (e.g., 6-minute walk test with oximetry), gas exchange (e.g., diffuse capacity of the lung for carbon monoxide), and lung volumes may also provide valuable insights where resources permit. Quality of life and symptom burden should be quantified using validated instruments such as the St. George’s Respiratory Questionnaire (SGRQ), modified Medical Research Council Dyspnea Scale, and the EuroQol 5 Dimensions (EQ-5D), ideally adapted to the local language and context. While the SGRQ has been applied in post-TB populations [18,43], its adaptation may be necessary for use in resource-limited settings to address TB-specific issues such as stigma and social isolation [44].

Cardiovascular risk stratification should be included in post-TB evaluations. Tools commonly used in the general population, such as the Framingham score and the atherosclerotic CVD [45] risk calculator, may underestimate the risk for TB survivors, and none have been specifically validated for this population. Emerging evidence suggests that latent TB is independently linked to subclinical atherosclerosis [46]. Until TB-specific tools are developed, a pragmatic, risk-factor-based approach should be adopted, emphasizing the screening of hypertension, dyslipidemia, diabetes, and smoking. For instance, diabetes is both a risk factor for developing TB and a common comorbidity among TB survivors, necessitating careful glycemic control to enhance anti-TB treatment outcomes and reduce post-TB complication [47]. Smoking is linked to increased severity of TB disease, delayed recovery, and higher rates of post-TB lung impairment, making smoking cessation a crucial aspect of care [48].

Neurological assessment is especially important for TB survivors with a history of CNS TB, such as TB meningitis or spinal TB. Common issues include physical disabilities, neurocognitive dysfunction, and psychi-atric symptoms, all of which necessitate structured follow-up. The modified Rankin Scale [49] is recommended at 12 months to assess functional recovery, in conjunction with domain-specific tools for cognition and mental health. For individuals with residual weakness, joint contractures, or spasticity, rehabilitation planning should address safety concerns, including fall risk, impaired balance, and diminished self-care ability.

A biopsychosocial approach to assessment, which integrates symptoms, functional ability, comorbidities, and contextual factors, provides the best opportunity for delivering person-centered care. The development and validation of severity scoring tools, along with standardized post-TB follow-up pathways, remain important priorities for research and implementation [50].

Survivors often encounter a range of challenges, including respiratory impairment, cardiovascular complications, mental health distress, social exclusion, and financial hardship, which cannot be effectively addressed through a purely biomedical model of care. Therefore, a holistic approach to post-TB life is urgently needed (Figure 3).

A holistic approach recognizes the interconnected nature of health determinants following TB and aims to address them through multidisciplinary, coordinated care. This process begins with collaboration across various specialties, including respiratory medicine, cardiology, mental health, rehabilitation, nutrition, and social work. For example, pulmonary rehabilitation, physical therapy, and nutritional support can significantly enhance function and prevent long-term disability [51]. While there are no specific CVD guidelines for TB, it is important to integrate interventions that control blood pressure, blood glucose, lipid levels, and lifestyle factors—such as smoking cessation, physical activity, and diet—into TB care. Collaboration between TB programs and primary care or non-communicable disease services is essential to ensure continuity, sustainability, and equitable delivery of cardiovascular care post-TB. Additionally, mental health services are crucial to address common conditions like depression, anxiety, and post-traumatic stress, which are often underdiagnosed in TB survivors.

The integration of TB care into broader chronic disease and primary care systems is a critical pillar. TB survivors often have comorbidities, and a siloed system may fail to effectively recognize or manage these issues. Additionally, framing TB as a standalone issue risks limiting its visibility and priority among policymakers and funders. Embedding post-TB care within integrated health services can strengthen advocacy for sustainable resources, ensure alignment with broader health agendas, and promote long-term, people-centered management. Establishing structured follow-up protocols—rather than discharging patients after treatment completion—enables early detection of complications and allows for tailored interventions as patient needs evolve.

Social and economic support is essential for achieving long-term recovery [52]. Programs that promote employment, financial security, housing, and community reintegration can restore autonomy and dignity. At the same time, care must be person-centered, reflecting each survivor's priorities, preferences, and values, rather than focusing solely on clinical outcomes. This approach includes shared decision-making, culturally sensitive communication, and flexibility in care planning.

To implement a holistic post-TB care model, several enabling factors must be addressed. First, national policies and guidelines should formally recognize post-TB disease and establish standards for follow-up care. Second, post-treatment surveillance systems are necessary to track outcomes and inform resource allocation. Third, training and sensitizing healthcare providers can enhance recognition of post-TB needs and help reduce stigma. Finally, actively engaging TB survivors and communities in designing, evaluating, and delivering services will ensure that care is relevant, equitable, and sustainable. For instance, national TB programs in Kenya, Uganda, Zambia, and Zimbabwe have trialed end-of-treatment assessments for comorbidities and disabilities, with feasibility studies indicating high acceptability [53]. Evidence from PTLD populations in Brazil, Italy, and France indicates that pulmonary rehabilitation enhances functional outcomes and quality of life, providing a compelling rationale for its inclusion in comprehensive post-TB care frameworks [54].

In addition to providing post-TB care, it is essential to focus on strategies aimed at preventing post-TB disease. This includes reducing the disease burden through early detection and prompt treatment, promoting public education to encourage timely care-seeking, and implementing innovative approaches during TB treatment, such as host-directed therapies that can modulate immune responses and reduce longterm complications. An effective response should be supported by standardized clinical guidelines, robust post-treatment surveillance systems, and sustainable financing mechanisms. Concurrently, research plays a crucial role in guiding these efforts. Key priorities include conducting longitudinal cohort studies [55,56] to understand the natural history of post-TB disease, developing risk stratification tools for targeted interventions, and evaluating rehabilitative and therapeutic methods to restore health and dignity to TB survivors.

Post-TB disease should be understood as a multidimensional condition that goes beyond lung health, affecting various physical, psychological, social, and economic aspects of life. Survivors encounter complex and often overlooked challenges that can persist for years after completing treatment. To effectively address these issues, a holistic, people-centered model of care is essential, emphasizing interdisciplinary collaboration and long-term system engagement.