Prophylactic antiviral treatment reduces the incidence of liver failure among patients coinfected with Mycobacterium tuberculosis and hepatitis B virus

Lian, Jiangshan; Ping, Hu; Lu, Yingfeng; Liu, Yueying; Wang, Xiaoxiao; Zhang, Yimin; Jia, Hongyu; Yang, Yida

doi:10.1016/j.virusres.2019.197664

Cited by 3 publications

(3 citation statements)

References 17 publications

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“…We used a stricter definition of DILI and provided a richer set of findings, which may facilitate providing references for clinical decision-making. Moreover, there is recent evidence that prophylactic antiviral therapy for HBV could reduce the incidence of DILI in patients with TB-HBV co-infection [40,41]. And a sequential rather than an incremental approach should be administered to reduce the probability of hepatotoxicity during TB therapy [42].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Drug-induced liver injury (DILI) is a common adverse drug reaction leading to interruption of tuberculosis (TB) therapy. We aimed to identify whether the hepatitis B virus (HBV) infection would increase the risk of DILI during first-line TB treatment. A meta-analysis of cohort studies searched in PubMed, Web of Science, and China National Knowledge Infrastructure was conducted. Effect sizes were reported as risk ratios (RRs) and 95% confidence intervals (CIs) and calculated by R software. Sixteen studies with 3960 TB patients were eligible for analysis. The risk of DILI appeared to be higher in TB patients co-infected with HBV (RR: 2.66; 95% CI: 2.13-3.32) than those without HBV infection. Moreover, patients with positive hepatitis B e antigen (HBeAg) were more likely to develop DILI (RR: 3.42; 95% CI: 1.95-5.98) compared to those with negative HBeAg (RR: 2.30; 95% CI: 1.66-3.18). Co-infection with HBV was not associated with a higher rate of anti-TB DILI in latent TB patients (RR: 4.48; 95% CI: 0.80-24.99). The effect of HBV infection on aggravating anti-TB DILI was independent of study participants, whether they were newly diagnosed with TB or not. Besides, TB and HBV co-infection patients had a longer duration of recovery from DILI compared to non-co-infected patients (SMD: 2.26; 95% CI: 1.87-2.66). To conclude, the results demonstrate that HBV infection would increase the risk of DILI during TB therapy, especially in patients with positive HBeAg, and close liver function monitoring is needed for TB and HBV co-infection patients.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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“…Patients co-infected with hepatitis B or C and tuberculosis are more likely to experience drug-induced hepatotoxicity and hepatic dysfunction relative to patients without viral hepatitis [163]. A recent study suggests that prophylactically treating hepatitis B infection may reduce the incidence of liver failure in patients co-infected with TB [164].…”

Section: Tdm In Patients With Hepatitismentioning

confidence: 99%

Therapeutic drug monitoring in patients with tuberculosis and concurrent medical problems

Märtson

Burch

Ghimire

et al. 2020

Expert Opinion on Drug Metabolism & Toxicology

139

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Introduction: Therapeutic drug monitoring (TDM) has been recommended for treatment optimization in tuberculosis (TB) but is only is used in certain countries e.g. USA, Germany, the Netherlands, Sweden and Tanzania. Recently, new drugs have emerged and PK studies in TB are continuing, which contributes further evidence for TDM in TB. The aim of this review is to provide an update on drugs used in TB, treatment strategies for these drugs, and TDM to support broader implementation.Areas covered: This review describes the different drug classes used for TB, multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB), along with their pharmacokinetics, dosing strategies, TDM and sampling strategies. Moreover, the review discusses TDM for patient TB and renal or liver impairment, patients co-infected with HIV or hepatitis, and special patient populations -children and pregnant women. Expert opinion: TB treatment has a long history of using 'one size fits all.' This has contributed to treatment failures, treatment relapses, and the selection of drug-resistant isolates. While challenging in resource-limited circumstances, TDM offers the clinician the opportunity to individualize and optimize treatment early in treatment. This approach may help to refine treatment and thereby reduce adverse effects and poor treatment outcomes. Funding, training, and randomized controlled trials are needed to advance the use of TDM for patients with TB.

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“…Early identification of HBV coinfection and initiation of antiviral therapy significantly reduces the risk of anti-TBassociated drug-induced injury. Lian et al 58 evaluated 90 consecutive HBV patients with concurrent TB infection and observed that prophylactic HBV antiviral therapy was associated with a significantly lower risk of developing anti-TB medication-related hepatotoxicity or liver failure (22.2% vs. 51.1%, adjusted odds ratio = 0.033, 95% CI: 0.007-0.154). Similarly, Lui et al 7 performed a population-level retrospective cohort study over a 16-year period in Hong Kong on 3698 patients with HBV-TB coinfection, among which 488 were on HBV antiviral therapy and 446 were started on HBV antiviral therapy within 1 year of TB diagnosis.…”

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confidence: 99%

Estimating Prevalence of Hepatitis B Virus Coinfection Among Adults With Tuberculosis

Wong

Hubbard

Bagley

et al. 2021

Journal of Clinical Gastroenterology

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Background: While patients with hepatitis B virus (HBV) infection and tuberculosis (TB) have similar risk factors, little is known regarding the prevalence of HBV and TB coinfection. We aim to evaluate the prevalence of HBV among patients with TB across world regions. Methods:We systematically reviewed the literature using PubMed from inception through September 1, 2019, to identify studies that provided data to calculate HBV coinfection prevalence among adults with TB infection. Prevalence estimates of HBV coinfection among TB patients were stratified by world regions and calculated using meta-analyses with random-effects models.Results: A total of 36 studies met inclusion criteria (4 from the Africa region, 6 from the Americas region, 5 from the Eastern Mediterranean region, 2 from European region, 6 from Southeast Asia region, and 13 from the Western Pacific region). On metaanalysis, overall pooled HBV coinfection prevalence among TB patients was 7.1%, but varied by world region. Region-specific pooled HBV prevalence among TB patients was highest in Africa region [11.4%, 95% confidence interval (CI): 3.45-19.31] and Western Pacific region (10.8%, 95% CI: 8.68-12.84), and was lowest in the Americas (2.2%, 95% CI: 0.78-3.53). Sensitivity analyses yielded similar HBV prevalence estimates across world regions. Conclusions:In this meta-analysis, we observed HBV coinfection prevalence among TB patients to be 38% to 450% higher than published estimates from the Polaris group of region-specific overall HBV prevalence. Timely identification of HBV infection among TB patients will improve patient outcomes by allowing for closer clinical monitoring and management, which may reduce the risk of liver dysfunction and liver failure related to TB treatment.

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Prophylactic antiviral treatment reduces the incidence of liver failure among patients coinfected with Mycobacterium tuberculosis and hepatitis B virus

Cited by 3 publications

References 17 publications

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

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

Therapeutic drug monitoring in patients with tuberculosis and concurrent medical problems

Estimating Prevalence of Hepatitis B Virus Coinfection Among Adults With Tuberculosis

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