Background: Mycobacterium tuberculosis (MTB) employs a variety of strategies to evade the host immune response, enabling its persistence and the development of tuberculosis. These evasion tactics involve thwarting lysosome formation, manipulating intracellular pH, and disrupting apoptosis and autophagy processes within host cells. Specifically, MTB interferes with lysosome acidification by modulating calcium ions (Ca2+), iron ions, and hydrogen ions (H+ ), creating an optimal environment for its survival within host cells. Furthermore, MTB inhibits host cell apoptosis and autophagy, critical defense mechanisms against intracellular pathogens. Understanding these immunological escape mechanisms is paramount for developing effective tuberculosis therapies. Future research should focus on targeting MTB evasion strategies to pave the way for innovative tuberculosis treatments. Conclusion: There is still a long road ahead of us to understand the immunological escape mechanism used by MTB. Over the past 50 years, numerous studies have looked into the immune response and the pathogenic processes of MTB.