title: Risk factors and algorithms to identify hepatitis C, hepatitis B, and HIV among Georgian tuberculosis patients.
abstract: OBJECTIVE
  To determine prevalence, risk factors, and simple identification algorithms for HIV, hepatitis B, and hepatitis C co-infection; factors that may predispose for anti-tuberculosis therapy-induced hepatotoxicity.
  
  
  METHODS
  We recruited 300 individuals at in-patient tuberculosis hospitals in three cities in Georgia, administered a behavioral questionnaire, and tested for antibody to HIV, hepatitis C (HCV), hepatitis B core antigen (anti-HBc), and the hepatitis B surface antigen (HBsAg).
  
  
  RESULTS
  Of the individuals tested, 0.7% were HIV positive, 4.3% were HBsAg positive, 8.7% were anti-HBc positive, and 12.0% were HCV positive. In multivariable analysis, a history of blood transfusion, injection drug use, and prison were significant independent risk factors for HCV, while a history of blood transfusion, injection drug use, younger age at sexual debut, and a high number of sex partners were significant risk factors for HBV. Three-questionnaire item algorithms predicted HCV serostatus 74.1% of the time and HBV serostatus 85.2% of the time.
  
  
  CONCLUSIONS
  Treatment of tuberculosis patients in resource-limited countries with concurrent epidemics of HCV, HBV, and HIV may be associated with significant hepatotoxicity. Serologic screening of tuberculosis patients for HBV, HCV, and HIV or using behavioral algorithms to identify patients in need of intensive monitoring during anti-tuberculosis therapy may reduce this risk.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Suite E7133, 615 N. Wolfe St., Baltimore, MD 21205, USA. mkunihol@jhsph.edu
authors.forename: Mark H
authors.initials: MH
authors.lastname: Kuniholm
authors.forename: Jennifer
authors.initials: J
authors.lastname: Mark
authors.forename: Malvina
authors.initials: M
authors.lastname: Aladashvili
authors.forename: N
authors.initials: N
authors.lastname: Shubladze
authors.forename: G
authors.initials: G
authors.lastname: Khechinashvili
authors.forename: Tengiz
authors.initials: T
authors.lastname: Tsertsvadze
authors.forename: Carlos
authors.initials: C
authors.lastname: del Rio
authors.forename: Kenrad E
authors.initials: KE
authors.lastname: Nelson
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000465:Algorithms; D015331:Cohort Studies; D005260:Female; D005846:Georgia (Republic) / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D006306:Health Surveys; D019694:Hepatitis B, Chronic / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D019698:Hepatitis C, Chronic / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011329:Prisoners; D012307:Risk Factors; D012725:Sexual Behavior; D015819:Substance Abuse, Intravenous; D014376:Tuberculosis / Q000150:complications* / Q000453:epidemiology