Sex Bias in Tuberculosis in the Developing World

Tuberculosis (TB), the most deadly global single organism infectious disease, kills nearly twice as many men as women. Understanding the factors that drive this bias in TB mortality is an important aspect of the global effort to reduce the enormous burden of this disease in the developing world. One third of the world’s population is estimated to be infected TB, with Low and Middle Income Countries (LMIC) bearing the greatest disease burden. In LMIC sex bias in TB is influenced by sociocultural, behavioural as well as biological factors, with dynamic interactions between reporting variables, other confounding variables and physiological mechanisms, which each influence one another to produce the male-biased sex ratio observed in TB transmission, prevalence and mortality. While confounding factors are addressed in the existing global drive to tackle TB it is the biological aspects of sex bias in TB that present specific challenges for diagnosis and treatment in men and women as they potentially influence future immunological-based interventions to treat TB.