Prevalence, drug-induced hepatotoxicity, and mortality among patients multi-infected with HIV, tuberculosis, and hepatitis virus

Mo, Pingzheng; Zhu, Qi; Teter, Caroline; Yang, Rongrong; Deng, Liping; Yan, Yajun; Zeng, Jie; Gui, Xien

doi:10.1016/j.ijid.2014.06.020

Cited by 30 publications

(36 citation statements)

References 21 publications

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“…This result was in agreement with those of recent studies performed in Brazil (Reis et al 2011) and China (Mo et al 2014). In Thailand, a study revealed a very high (31%) anti-HCV prevalence among HIV/TB-coinfected patients (Sirinak et al 2008).…”

Section: Discussionsupporting

confidence: 94%

“…The proportion of patients with TB that were HCV carriers (17/138, 12%) was about eight times higher than that observed in the urban Brazilian population, despite the fact that patients with elevated serum transaminase levels were excluded from this study. Such high rates of HCV may be clinically significant, considering that the incidence of abnormal liver function tests (and even mortality) with anti-TB treatment is higher in HCV-infected individuals than in the non-infected (Nader et al 2010, Lomtadze et al 2013, Mo et al 2014). …”

Section: Discussionmentioning

confidence: 99%

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Prevalence of hepatitis C virus and human immunodeficiency virus in a group of patients newly diagnosed with active tuberculosis in Porto Alegre, Southern Brazil

Costi

Grandi

Halon

et al. 2017

Mem. Inst. Oswaldo Cruz

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BACKGROUND Porto Alegre is the Brazilian state capital with second highest incidence of tuberculosis (TB) and the highest proportion of people infected with human immunodeficiency virus (HIV) among patients with TB. Hepatitis C virus (HCV) infection increases the risk of anti-TB drug-induced hepatotoxicity, which may result in discontinuation of the therapy.OBJECTIVES The aim of this study was (i) to estimate prevalence of HCV and HIV in a group of patients newly diagnosed with active TB in a public reference hospital in Porto Alegre and (ii) to compare demographic, behavioural, and clinical characteristics of patients in relation to their HCV infection status.METHODS One hundred and thirty-eight patients with TB were tested for anti-HCV antibody, HCV RNA, and anti-HIV1/2 antibody markers. HCV RNA from real-time polymerase chain reaction (PCR)-positive samples was submitted to reverse transcription and PCR amplification. The 5′ non-coding region of the HCV genome was sequenced, and genotypes of HCV isolates were determined.FINDINGS Anti-HCV antibody, HCV RNA, and anti-HIV antibodies were detected in 27 [20%; 95% confidence interval (CI), 13-26%], 17 (12%; 95% CI, 7-18%), and 34 (25%; 95% CI, 17-32%) patients, respectively. HCV isolates belonged to genotypes 1 (n = 12) and 3 (n = 4). Some characteristics were significantly more frequent in patients infected with HCV. Among them, non-white individuals, alcoholics, users of illicit drugs, imprisoned individuals, and those with history of previous TB episode were more commonly infected with HCV (p < 0.05).MAIN CONCLUSIONS HCV screening, including detection of anti-HCV antibody and HCV RNA, will be important to improving the management of co-infected patients, given their increased risk of developing TB treatment-related hepatotoxicity.

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Section: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Prevalence of hepatitis C virus and human immunodeficiency virus in a group of patients newly diagnosed with active tuberculosis in Porto Alegre, Southern Brazil

Costi

Grandi

Halon

et al. 2017

Mem. Inst. Oswaldo Cruz

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“…Evidence suggests that HBV carriers tend to develop ATDILI. 13,27,28 However, the association between HBV carrier status and ATDILI in TB patients receiving chemotherapy is still controversial. 11 In most of the previous studies, HBV carriers were identified as HBsAg positive.…”

Section: Discussionmentioning

confidence: 99%

Prevalence, risk factors, management, and treatment outcomes of first-line antituberculous drug-induced liver injury: a prospective cohort study

Sun

Zhang

et al. 2016

Pharmacoepidemiol Drug Saf

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“…The presence of HBV during TB treatment can increase the risk of DILI. Due to this, multi‐infection with TB/HIV/HBV increases the morbidity and mortality, as these comorbidities are more complicated and difficult to treat, becoming a challenge for health care and public health …”

Section: Introductionmentioning

confidence: 99%

“…Due to this, multi-infection with TB/HIV/HBV increases the morbidity and mortality, as these comorbidities are more complicated and difficult to treat, becoming a challenge for health care and public health. 9 Thus, could OBI also represent an increased risk of DILI? So far, no previous studies have dealt with OBI prevalence in this TB population.…”

mentioning

confidence: 99%

Occult hepatitis B virus infection: clinical implications in tuberculosis treatment

Trigo

Brasil

Costa

et al. 2016

Journal of Viral Hepatitis

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Occult hepatitis B virus infection (OBI) is characterized by the absence of HBsAg and persistence of the virus genome (HBV-DNA) in liver tissue and/or blood. OBI has been reported in several clinical contexts. However, the clinical significance of OBI in tuberculosis (TB) treatment is unknown. We investigated the OBI prevalence and its impact on the risk of drug-induced liver injury (DILI) during TB treatment. This was a prospective cohort study with one hundred patients who were treated for TB from 2008 to 2015. Laboratory, clinical and demographic data of TB patients were extracted from medical records. Based on HBV-DNA testing of serum samples, an OBI prevalence of 12% was established; almost half of these patients had both anti-HBc and anti-HBs serological markers. Low CD4 cell counts have been shown to be a risk factor for OBI among TB patients co-infected with HIV (P=.036). High DILI incidence was observed in this study. A multivariable Cox proportional hazard model was conducted and identified OBI (HR 2.98, 95% CI 1.30-6.86) as the strongest predictor for DILI when adjusted to CD4 cell count (HR 0.38, 95% CI 0.17-0.90), ALT before TB treatment (HR 1.37, 95% CI 0.81-2.32) and TB extrapulmonary clinical form (HR 2.91, 95% CI 1.75-7.21). The main aim of this study was to highlight DILI as a clinical outcome during treatment of TB patients with OBI. Therefore, HBV-DNA testing should be considered routinely in monitoring DILI, and also in other clinical implications associated with OBI, reduce morbidity and mortality.

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Prevalence, drug-induced hepatotoxicity, and mortality among patients multi-infected with HIV, tuberculosis, and hepatitis virus

Abstract: HIV, HBV, and HCV are risk factors for the development of abnormal LFTs and mortality during anti-TB treatment. TB patients co-infected with HIV and hepatitis virus need close follow-up.

Cited by 30 publications

References 21 publications

Prevalence of hepatitis C virus and human immunodeficiency virus in a group of patients newly diagnosed with active tuberculosis in Porto Alegre, Southern Brazil

Prevalence of hepatitis C virus and human immunodeficiency virus in a group of patients newly diagnosed with active tuberculosis in Porto Alegre, Southern Brazil

Prevalence, risk factors, management, and treatment outcomes of first-line antituberculous drug-induced liver injury: a prospective cohort study

Occult hepatitis B virus infection: clinical implications in tuberculosis treatment

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