Mycobacterium tuberculosis disease associates with higher HIV-1-specific antibody responses

Mycobacterium tuberculosis (Mtb) can enhance immune responses against unrelated pathogens. Although Mtb is the most common co-infection in people living with HIV (PWH), there has been no examination of its impact on HIV-1 immune responses. Plasma neutralization and antibody dependent cellular cytotoxicity (ADCC) was compared among PWH and Mtb disease (PWH/Active Mtb) and PWH/No Mtb both prior to and after antiretroviral treatment (ART) and completion of Mtb therapy. We assessed HIV-1 sequences, total antibody quantities and isotypes, and plasma cytokine levels to ascertain mechanisms that affect humoral responses. HIV-1 neutralizing antibodies (nAbs) were broader and more potent in PWH/Active Mtb as compared to PWH/No Mtb, and nAbs increased among PWH who developed Mtb after ART initiation. ADCC was also higher in the PWH who had Mtb disease after starting ART. PWH/Active Mtb as compared to PWH/No Mtb had unique HIV-1 envelope sequence motifs associated with neutralization resistance further implying differences in humoral selection. The Mtb-linked antibody augmentation associated with elevated plasma cytokine levels important for B cells and antibody production, namely interleukin-6, a proliferation-inducing ligand (APRIL), and B-cell activating factor (BAFF). Increased plasma virus levels, greater HIV-1 envelope diversity, higher levels of all antibodies, and cross-reactive responses did not explain the enhanced HIV-1 humoral responses in those with Mtb. Mtb disease enhances HIV-1 humoral responses likely by perturbing pathways important for antibody production in lymphoid tissue that has both pathogens. These findings have implications for using antibody-based therapies and inducing optimal HIV-1 antibody responses. Author Summary Mycobacterium tuberculosis (Mtb) is the most common infection among people with HIV (PWH) in the world. Mtb infection can enhance immune responses against unrelated pathogens. Previous studies have not examined the impact of Mtb disease on HIV antibodies in PWH. This information has importance for future strategies aimed at enhancing HIV antibody responses in naïve individuals or PWH. We show that HIV neutralizing antibodies and antibody-dependent cellular cytotoxicity are broader and more potent in PWH in the presence as compared to the absence of Mtb disease. PWH and Mtb disease as compared to those without Mtb also harbor unique HIV envelope sequences, which further indicates that there is differential antibody selection pressure. The Mtb linked HIV antibody enhancement associated with specific mediators important for B cell and antibody development. Importantly, the Mtb mediated HIV antibody augmentation was not due to cross-reactivity, a generalized increase in all antibodies, or a higher level, more diverse, or longer duration of antigen exposure. We speculate that more potent HIV antibodies arise in lymphatic tissue that harbors both Mtb and HIV. Our findings have implications for both future uses of HIV antibodies as prophylaxis or treatment and strategies aimed inducing better HIV antibody responses.