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TB: from diagnosis to management
P63 The prevalence of viral hepatitis in patients undergoing anti-tuberculous therapy
  1. M Asgheddi1,
  2. D W Connell2,
  3. H A Nooredinvand1,
  4. M Abdullah1,
  5. M O'Donoghue2,
  6. L Campbell1,
  7. A Lalvani2,
  8. M Wickremasinghe2,
  9. S Khan1,
  10. O M Kon2
  1. 1Hepatology and Gastroenterology Section, Division of Diabetes Endocrinology and Metabolism, Department of Medicine, Imperial College Healthcare NHS Trust, London, UK
  2. 2Tuberculosis Service, Chest and Allergy Clinic, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK

Abstract

Background One-third of the world's population is thought to be infected with Mycobacterium tuberculosis (Mtb); the highest incidence rates for active disease are found in the WHO's South-East Asian and African regions. Hepatitis B virus (HBV) and Hepatitis C virus (HCV) each infect about 0.3% of the UK population. HBV/HCV are treatable but largely asymptomatic until advanced liver disease and/or cancer. Screening for HBV/HCV is recommended in high-risk individuals but is not routinely performed in TB patients. HBV/HCV share similar epidemiological “hotspots” to TB, and several studies, primarily in South America and East Asia, have shown an increased prevalence of HBV/HCV in TB patients and an association between HBV/HCV and Drug Induced Liver Injury (DILI) following anti-TB therapy. No such analysis has been performed in the UK.

Aims To assess

  1. The prevalence of markers of HBV and HCV infection in patients undergoing anti-TB therapy.

  2. Whether serological evidence of HBV/HCV increases risk of DILI.

Method A prospective study on 429 TB patients receiving anti-TB therapy in a diverse urban TB clinic. Serological markers of HBV/HCV/HIV infection were documented. ALT was measured prior to treatment and 2–4 weeks after treatment initiation. DILI was defined as an ALT rise of greater than 2-times upper limit of normal following a normal pre-treatment level (<40 IU/ml).

Results 58.7% of patients were from either South-East Asia or Africa. 61 (14.2%) patients were isolated anti-HBc antibody positive (Anti-HBc), 11 (2.6%) were Hepatitis B surface antigen positive (HBsAg) and 7 (1.6%) were HCV antibody positive. The prevalence of active HBV/HCV infection was significantly higher than the estimated UK prevalence in this urban TB clinic. Three (5.3%) patients with serological evidence of HBV/HCV had DILI compared to 25 (9.5%) of those without.

Conclusion HBV/HCV prevalence is higher among TB patients and routine screening for viral hepatitis should be considered in this group. DILI was not increased in patients with serological markers of HBV/HCV.

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