Reading immune restoration through Mycobacterium tuberculosis intrahost evolution.

Mycobacterium tuberculosis genomes in macaques reveal distinct evolutionary paths under ART and SIV coinfection, with ART associated with oxidative damage variants.

• Why it matters: Understanding how immune restoration occurs during ART is crucial because ART does not fully protect against tuberculosis, and the mechanisms behind this gap are not well understood.
• What they did: The study used population-level genome sequencing of M. tuberculosis in macaques to compare bacterial evolution in SIV coinfected versus ART-treated animals, identifying different mutation patterns.
• The result: Findings suggest pathogen genomes can serve as indirect indicators of immune environment, guiding future research to link genomic signatures with immune recovery, persistence, and transmission.