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

• Published in: PloS one 2013-12, Vol.8 (12), p.e83892
• Main Authors: Lomtadze, Nino, Kupreishvili, Lali, Salakaia, Archil, Vashakidze, Sergo, Sharvadze, Lali, Kempker, Russell R, Magee, Matthew J, del Rio, Carlos, Blumberg, Henry M
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Alanine; Alanine transaminase; Alcohol use; Antitubercular agents; Antitubercular Agents - adverse effects; Antitubercular Agents - therapeutic use; Blood & organ donations; Chronic infection; Coinfection; Development and progression; Drug resistance; Drug therapy; Enzymes; Epidemiology; Female; Georgia - epidemiology; Global health; Hazards; Health aspects; Health risks; Hepatitis; Hepatitis B; Hepatitis B - complications; Hepatitis B - epidemiology; Hepatitis B surface antigen; Hepatitis C; Hepatitis C - complications; Hepatitis C - epidemiology; Hepatitis C - genetics; Hepatitis C virus; Hepatotoxicity; HIV; HIV Infections - complications; HIV Infections - epidemiology; Human immunodeficiency virus; Humans; Infections; Infectious diseases; Laboratories; Liver; Liver - drug effects; Lung diseases; Male; Medical diagnosis; Medical research; Medicine; Middle Aged; Patients; Population; Prevalence; Public health; Risk Factors; Serology; Side effects; Substance abuse treatment; Systematic review; Tuberculosis; Tuberculosis, Pulmonary - complications; Tuberculosis, Pulmonary - drug therapy; Tuberculosis, Pulmonary - epidemiology; Viruses; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0083892

The country of Georgia has a high prevalence of tuberculosis (TB) and hepatitis C virus (HCV) infection. To determine whether HCV co-infection increases the risk of incident drug-induced hepatitis among patients on first-line anti-TB drug therapy. 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. 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. 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.