Given that infection with Mycobacterium tuberculosis (Mtb) is the leading cause of death amongst individuals living with HIV, understanding the complex mechanisms by which Mtb exacerbates HIV infection may lead to improved treatment options or adjuvant therapies. While it is well-understood how HIV compromises the immune system and leaves the host vulnerable to opportunistic infections such as Mtb, less is known about the interplay of disease once active Mtb is established. This review explores how glutathione (GSH) depletion, T cell exhaustion, granuloma formation, and TNF-α upregulation, as a result of Mtb infection, leads to an increase in HIV disease severity. This review also examines the difficulties of treating coinfected patients and suggests further research on the clinical use of GSH supplementation.

Objectives This study aims to investigate what factors correlate with osteopathic medical students’ preparedness to provide care for the LGBTQ+ community through a multi-institutional survey. Context This is one of the few formal research projects to assess the impact of LGBTQ+ medical education on osteopathic students’ comfort level with caring for the community. Methods This study was approved by the IRB at Western University of Health Sciences, Pomona, CA on 11/19/2020. An 18-question survey was created regarding the exposure to the LGBTQ+ population and healthcare education before and after attending osteopathic medical schools. The anonymous survey was electronically distributed at Western University of Health Sciences College of Osteopathic Medicine Pacific and Pacific Northwest, Idaho College of Osteopathic Medicine, Touro University, Philadelphia College of Osteopathic Medicine, Rocky Vista University College of Osteopathic Medicine, and Michigan State University College of Osteopathic Medicine between 1/6/21 and 5/8/21. The survey information was statistically analyzed via SAS University edition. Results The survey had 441 responses: 63% were female, 34% were male, and 3% selected other gender identities. From 441 responses to the survey, 378 responses were analyzed using a logistics regression model to comprehensively model a binary-dependent variable for the students’ preparedness. Students knowing the meaning of the acronym LGBTQ+ (p =0.04) and actively engaging in extracurricular activities for the LGBTQ+ population (p =0.01) showed the strongest correlation based on the logistic regression analysis. Additionally, Chi-square results identified 6 independent variables associated with students’ preparedness to care for the LGBTQ+ population: being a second year or a third year osteopathic medical student (p <0.01), having opportunities to learn about the LGBTQ+ population in college (p <0.01), having a formal presentation about LGBTQ+ health in medical school (p <0.01), the medical school offering extracurricular activities about the LGBTQ+ population (p <0.01), knowing what the LGBTQ+ acronym stands for (p =0.01), and actively being involved in extracurricular activities concerning the LGBTQ+ community (p=0.03). Conclusions Our study indicates that medical students’ educational exposure through college and medical school is a more correlating influencing factor for their preparedness to care for the LGBTQ+ population in comparison with student’s gender, hometown size, or socioeconomic, geographical, and religious background. Future studies to objectively identify medical students’ preparedness and experience with LGBTQ+ patients, as well as studying effective curricula for filling in knowledge gaps, will be necessary.