Hepatitis C virus co-infection increases the risk of anti-tuberculosis drug-induced hepatotoxicity among patients with pulmonary tuberculosis.

Abstract

BACKGROUND:

The country of Georgia has a high prevalence of tuberculosis (TB) and hepatitis C virus (HCV) infection.

PURPOSE:

To determine whether HCV co-infection increases the risk of incident drug-induced hepatitis among patients on first-line anti-TB drug therapy.

METHODS:

Prospective cohort study; HCV serology was obtained on all study subjects at the time of TB diagnosis; hepatic enzyme tests (serum alanine aminotransferase [ALT] activity) were obtained at baseline and monthly during treatment.

RESULTS:

Among 326 study patients with culture-confirmed TB, 68 (21%) were HCV co-infected, 14 (4.3%) had chronic hepatitis B virus (HBV) infection (hepatitis B virus surface antigen positive [HBsAg+]), and 6 (1.8%) were HIV co-infected. Overall, 19% of TB patients developed mild to moderate incident hepatotoxicity. In multi-variable analysis, HCV co-infection (adjusted Hazards Ratio [aHR]=3.2, 95% CI=1.6-6.5) was found to be an independent risk factor for incident anti-TB drug-induced hepatotoxicity. Survival analysis showed that HCV co-infected patients developed hepatitis more quickly compared to HCV seronegative patients with TB.

CONCLUSION:

A high prevalence of HCV co-infection was found among patients with TB in Georgia. Drug-induced hepatotoxicity was significantly associated with HCV co-infection but severe drug-induced hepatotoxicity (WHO grade III or IV) was rare.

• Authors: Nino Lomtadze, Lali Kupreishvili, Archil Salakaia, Sergo Vashakidze, Lali Sharvadze, Russell R Kempker, Matthew J Magee, Carlos del Rio, Henry M Blumberg
• Journal: PloS one (PLoS One) Vol. 8 Issue 12 Pg. e83892 ( 2013) ISSN: 1932-6203 [Electronic] United States
• PMID: 24367617 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, Non-P.H.S.)

Chemical References

• Antitubercular Agents

Topics

• Adult
• Aged
• Aged, 80 and over
• Antitubercular Agents (adverse effects, therapeutic use)
• Coinfection
• Female
• Georgia (epidemiology)
• HIV Infections (complications, epidemiology)
• Hepatitis B (complications, epidemiology)
• Hepatitis C (complications, epidemiology, genetics)
• Humans
• Liver (drug effects)
• Male
• Middle Aged
• Prevalence
• Risk Factors
• Tuberculosis, Pulmonary (complications, drug therapy, epidemiology)
• Young Adult