Human immunodeficiency virus (HIV) and Mycobacterium tuberculosis (Mtb) co-infection remains a critical global health challenge. Their synergistic interaction disrupts innate and adaptive immunity, establishing a vicious cycle of immune dysfunction and pathology. Currently, Mtb remains the leading cause of death in people living with HIV, and HIV is an independent risk factor for Mtb. Although Combination antiretroviral therapy (cART) and anti-tuberculosis treatment have reduced morbidity and mortality, co-infected patients still face risks including incomplete immune reconstitution, persistent inflammation, and poor prognosis. Therefore, novel adjuvant therapeutic strategies are urgently needed. This paper reviews recent advances in the pathological mechanisms and adjunctive therapies for HIV/Mtb co-infection, aiming to inform clinical strategies and interventions