Long TB: Framing post-acute sequelae of tuberculosis as a distinct clinical entity.

Abstract

Tuberculosis (TB) has historically been declared cured at the point of microbiological clearance. Yet emerging evidence from systematic reviews and cohort studies demonstrates that between 30% and 80% of pulmonary TB survivors experience persistent symptoms, organ damage or functional impairment after treatment completion; a burden that existing outcome metrics fail to capture. We propose the term Long TB, with the formal designation Post-Acute Sequelae of Tuberculosis (PAST-TB), as a conceptual and clinical framework to define, study and address this under-recognised morbidity. Drawing explicit parallels with Long COVID (post-acute sequelae of SARS-CoV-2 or PASC), we argue that the Long TB framing is not merely rhetorical but scientifically grounded, strategically powerful and urgently needed. With approximately 155 million TB survivors alive globally and modelling studies attributing up to 47% of TB-related disability-adjusted life years (DALYs) to the post-treatment period, the case for a systematic post-TB care agenda, anchored by this new terminology is compelling. We attempt to outline the multi-system domains of Long TB, its shared pathological drivers with PASC and the programmatic and research reforms required to move from bacteriological to biological cure as the standard of care.