Background Screening for viral hepatitis is not routinely recommended in patients diagnosed with tuberculosis (TB). However there are significant similarities in the global distribution of TB and hepatitis B (HBV) and C (HCV). It remains unclear whether co-infection with HBV or HCV is a risk factor for hepatotoxicity in patients receiving anti-tuberculous therapy and significant morbidity and mortality is associated with a late diagnosis.
Objectives To determine the prevalence of HBV and HCV infection among new cases of active TB across treatment centres in East London and to assess the adverse drug reactions to anti-tuberculous treatment experienced by this population.
Methods We conducted a retrospective study including all patients diagnosed with active TB during 2013 at two TB clinics in London. Data on demographic characteristics, HBV surface antigen (HBsAg), HCV antibody, human immunodeficiency virus (HIV) and adverse drug reactions were retrospectively analysed.
Results In total, 472 cases of active TB were notified during 2013. The mean age was 37.7 (+/- 15.3) years (range: 5–92). Males accounted for 62.3% of our cohort. 84.7% of patients were born outside of the UK with the majority of patients being born in either Bangladesh (16.5%), India (27.8%) or Pakistan (15.9%). Overall, 304 patients were screened for HBV, 302 for HCV, and 447 for HIV. Of those screened, HBsAg was detected in 3.3%, HCV antibody in 2.0% and HIV in 3.4%. All patients infected with HBV or HCV were foreign born. Hepatotoxicity was defined as an ALT greater than 5 times the upper limit of normal or requiring a change in treatment. There was no significant difference in rates of hepatotoxicity in either in HepBsAg status (p = 0.371), HCV status (p = 0.597) or HIV status (p = 0.413) but numbers of HBV and HCV infection were small.
Conclusions The prevalence of HBV and HCV was significantly higher in our cohort of TB patients than the background UK prevalence, which is 0.4% for HCV, 0.3% for HBV and 0.15% for HIV. Routine screening for HBV and HCV on an opt-out basis would be justified in our setting given the high proportion of foreign-born patients. Further research into the magnitude of HBV/HCV co-infection with active or latent TB, any increased risk in drug-induced hepatotoxicity and the cost-effectiveness of routine screening is needed.
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