title: Hepatitis C virus co-infection increases the risk of anti-tuberculosis drug-induced hepatotoxicity among patients with pulmonary tuberculosis.
abstract: BACKGROUND
  The country of Georgia has a high prevalence of tuberculosis (TB) and hepatitis C virus (HCV) infection.
  
  
  OBJECTIVE
  To determine whether HCV co-infection increases the risk of incident drug-induced hepatitis among patients on first-line anti-TB drug therapy.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia.
authors.forename: Nino
authors.initials: N
authors.lastname: Lomtadze
authors.affiliation: National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia.
authors.forename: Lali
authors.initials: L
authors.lastname: Kupreishvili
authors.affiliation: National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia.
authors.forename: Archil
authors.initials: A
authors.lastname: Salakaia
authors.affiliation: National Center for Tuberculosis and Lung Diseases, Tbilisi, Georgia.
authors.forename: Sergo
authors.initials: S
authors.lastname: Vashakidze
authors.affiliation: Infectious Diseases, AIDS and Clinical Immunology Research Center, Tbilisi, Georgia.
authors.forename: Lali
authors.initials: L
authors.lastname: Sharvadze
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America.
authors.forename: Russell R
authors.initials: RR
authors.lastname: Kempker
authors.affiliation: Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, Georgia, United States of America.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Magee
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America ; Hubert Department of Global Health, Rollins School of Public Health of Emory University, Atlanta, Georgia, United States of America.
authors.forename: Carlos
authors.initials: C
authors.lastname: del Rio
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, United States of America ; Hubert Department of Global Health, Rollins School of Public Health of Emory University, Atlanta, Georgia, United States of America ; Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, Georgia, United States of America.
authors.forename: Henry M
authors.initials: HM
authors.lastname: Blumberg
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000009:adverse effects* / Q000627:therapeutic use; D060085:Coinfection; D005260:Female; D005845:Georgia / Q000453:epidemiology; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology; D006509:Hepatitis B / Q000150:complications / Q000453:epidemiology; D006526:Hepatitis C / Q000150:complications* / Q000453:epidemiology / Q000235:genetics; D006801:Humans; D008099:Liver / Q000187:drug effects*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000188:drug therapy* / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000995:Antitubercular Agents