title: Hepatitis C virus infection increases hepatitis risk during anti-tuberculosis treatment.
abstract: OBJECTIVE
  To study the impact of hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection on clinically significant transaminase elevation during short-course anti-tuberculosis treatment.
  
  
  METHODS
  Retrospective observation study.
  
  
  RESULTS
  During standard anti-tuberculosis treatment of 295 patients with active pulmonary tuberculosis (TB) and normal baseline liver biochemical tests, 25 (8.5%) developed hepatitis and had a significantly higher mortality rate (32% vs. 7%, OR 6.22, 95%CI 2.0-17.6, P = 0.001). Multivariate analysis showed that HCV co-infected individuals were more likely to develop transaminase elevations (OR 3.43, 95%CI 1.14-10.35, P = 0.03) than those without HCV co-infection. They also had a longer duration of transaminase elevation than controls (43.3 +/- 40.4 vs. 13.5 +/- 8.6 days, P = 0.01). Co-infection with HBV was not associated with a higher rate of hepatitis but was associated with later onset (102 +/- 68.7 vs. 37.0 +/- 31.9 days, P = 0.01), higher peak alanine aminotransferase level and slower recovery (55.5 +/- 62.9 vs. 15.4 +/- 10.8 days, P = 0.01).
  
  
  CONCLUSIONS
  Even with normal baseline liver biochemical tests, HCV co-infection had a higher incidence and longer exacerbations of hepatitis during anti-tuberculosis treatment. We suggest that screening for HCV infection before starting anti-tuberculosis treatment is helpful in planning the frequency of follow-up visits.
authors.affiliation: Chest Hospital, Department of Health, Executive Yuan, Rende Township, Tainan County, Taiwan. jefferycjyu@ntu.edu.tw
authors.forename: J-Y
authors.initials: JY
authors.lastname: Chien
authors.forename: R-M
authors.initials: RM
authors.lastname: Huang
authors.forename: J-Y
authors.initials: JY
authors.lastname: Wang
authors.forename: S-Y
authors.initials: SY
authors.lastname: Ruan
authors.forename: Y-J
authors.initials: YJ
authors.lastname: Chien
authors.forename: C-J
authors.initials: CJ
authors.lastname: Yu
authors.forename: P-C
authors.initials: PC
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001219:Aspartate Aminotransferases / Q000378:metabolism; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D013997:Time Factors; D000637:Transaminases / Q000378:metabolism; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy* / Q000401:mortality
chemical_list: D000995:Antitubercular Agents; D000637:Transaminases; D001219:Aspartate Aminotransferases