High incidence of tuberculosis in patients treated for hepatitis C chronic infection

• Published in: The Brazilian journal of infectious diseases 2016-03, Vol.20 (2), p.205-209
• Main Authors: de Oliveira Uehara, Silvia Naomi, Emori, Christini Takemi, Perez, Renata Mello, Mendes-Correa, Maria Cassia Jacintho, de Souza Paiva Ferreira, Adalgisa, de Castro Amaral Feldner, Ana Cristina, Silva, Antonio Eduardo Benedito, Filho, Roberto José Carvalho, de Souza e Silva, Ivonete Sandra, Ferraz, Maria Lucia Cardoso Gomes
• Format: Article
• Language: English
• Subjects: Adult; Alpha-interferon; Antiviral Agents - adverse effects; Antiviral Agents - therapeutic use; Brazil - epidemiology; Brief Communication; Coinfection - epidemiology; Diagnosis; Female; Hepatitis C; Hepatitis C, Chronic - drug therapy; Hepatitis C, Chronic - epidemiology; Humans; Incidence; INFECTIOUS DISEASES; Interferon-alpha - adverse effects; Interferon-alpha - therapeutic use; Latent tuberculosis infection; Male; Middle Aged; Physiological aspects; Retrospective Studies; Tuberculosis; Tuberculosis - epidemiology; Tuberculosis - immunology
• ISSN: 1413-8670; 1678-4391; 1678-4391
• DOI: 10.1016/j.bjid.2015.12.003

Brazil is one of the 22 countries that concentrates 80% of global tuberculosis cases concomitantly to a large number of hepatitis C carriers and some epidemiological risk scenarios are coincident for both diseases. We analyzed tuberculosis cases that occurred during α-interferon-based therapy for hepatitis C in reference centers in Brazil between 2001 and 2012 and reviewed their medical records. Eighteen tuberculosis cases were observed in patients submitted to hepatitis C α-interferon-based therapy. All patients were human immunodeficiency virus-negative. Nine patients (50%) had extra-pulmonary tuberculosis; 15 (83%) showed significant liver fibrosis. Hepatitis C treatment was discontinued in 12 patients (67%) due to tuberculosis reactivation and six (33%) had sustained virological response. The majority of patients had a favorable outcome but one died. Considering the evidences of α-IFN interference over the containment of Mycobacterium tuberculosis, the immune impairment of cirrhotic patients, the increase of tuberculosis case reports during hepatitis C treatment with atypical and severe presentations and the negative impact on sustained virological response, we think these are strong arguments for latent tuberculosis infection screening before starting α-interferon-based therapy for any indication and even to consider IFN-free regimens against hepatitis C when a patient tests positive for latent tuberculosis infection.