Co-infection with hepatitis B virus among tuberculosis patients is associated with poor outcomes during anti-tuberculosis treatment

Abstract

BackgroundTuberculosis (TB) and chronic Hepatitis B virus (HBV) infection are common in China. Fist-line anti-TB medications often produce drug-induced liver injury (DILI). This study sought to investigate whether TB patients with chronic HBV co-infection are more susceptible to liver failure and poor outcomes during anti-TB treatment.MethodsEighty-four TB patients developed DILI during anti-TB treatment and were enrolled, including 58 with chronic HBV co-infection (TB-HBV group) and 26 with TB mono-infection (TB group). Clinical data and demographic characteristics were reviewed. The severity of DILI and incidences of liver failure and death were compared. Risk factors of clinical outcomes were defined.ResultsThe patterns of DILI were similar in both groups. Compared with patients in the TB group, patients in the TB-HBV group who did not receive anti-HBV therapy before anti-TB treatment were more susceptible to Grade-4 severity of DILI (36.2% vs. 7.7%, P = 0.005), liver failure (67.2% vs. 38.5%, P = 0.013) and poor outcomes (37.9% vs. 7.7%, P = 0.005). Age > 50 years (48.1% vs. 22.6%, P = 0.049), cirrhosis (50.0% vs. 15.4%, P = 0.046) and total bilirubin > 20 mg/dl (51.6% vs. 14.8%, P = 0.005) were independent risk factors for the rate of death in the TB-HBV group, and HBV DNA > 20,000 IU/ml had borderline significance (44.1% vs. 20.8%, P = 0.081). In the TB-HBV group, nucleos(t)ide analogues as rescue therapy were not able to reduce short-term death (33.3% vs. 36.8%, P = 0.659) once liver failure had occurred.ConclusionsPatients on anti-TB therapy with chronic HBV co-infection are more susceptible to developing liver failure and having poor outcomes during anti-TB treatment. Regular monitoring of liver function and HBV DNA level is mandatory. Anti-HBV treatment should be considered in those with high viral levels before anti-TB treatment.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3192-8) contains supplementary material, which is available to authorized users.

Impacts of hepatitis B and hepatitis C co-infection with tuberculosis, a prospective cohort study

“…Hepatitis B infection decreased the treatment success rate of tuberculosis by 20.6%; Hepatitis C viral infection decreased the treatment success rate of tuberculosis by 35.7%. This finding agrees with 2018 finding from China that indicates having hepatitis B or C decreased the treatment success rate [19]. This might be due to poor adherence of anti-TB drugs, poor bioavailability and metabolism of the drugs due to repeated vomiting as a result of hepatitis virus infections [42].…”

“…Hepatitis B or hepatitis C co-infection with tuberculosis increase the risk of treatment failure [19] activates latent tuberculosis [20][21][22], increase the risk of mortality [23], and drug-induced liver injury [24][25][26][27][28].…”

Hepatitis C Virus Affects Tuberculosis-Specific T Cells in HIV-Negative Patients

“…Chen et al [28] analyzed the effect of HBV/TB coinfection in a retrospective investigation and showed that TB/HBV patients who did not receive anti-HBV treatment were more susceptible to Grade 4 drug-induced liver injury, liver failure, and poor outcomes compared with TB-monoinfected patients. Similarly, Chukwuanukwu et al [29] found that coinfection with TB and malaria weakened immune responses to TB and was associated with an increase in anti-inflammatory cytokine IL-10.…”

The role of hepatitis B infection in anti-tuberculosis drug-induced liver injury: a meta-analysis of cohort studies

“…Additional 18 additional articles were identified through a manual search of reference lists from the relevant original and review articles. Finally, we screened 121 full-text articles and selected 16 articles for inclusion in the meta-analysis, including 10 English-language papers and 6 Chinese-language papers [11,12,[17][18][19][20][21][22][23][24][25][26][27][28][29][30].…”