title: Prevalence, drug-induced hepatotoxicity, and mortality among patients multi-infected with HIV, tuberculosis, and hepatitis virus.
abstract: OBJECTIVE
  To investigate the prevalence, incidence of abnormal liver function tests (LFTs), and mortality during anti-TB treatment in patients multi-infected with HIV, tuberculosis (TB), and hepatitis virus (hepatitis B virus (HBV) and hepatitis C virus (HCV)).
  
  
  METHODS
  Three hundred and sixty-one HIV-positive TB patients were enrolled and divided into an HIV/TB group, HIV/TB/HBV group, and HIV/TB/HCV group; 1013 HIV-negative TB patients were selected randomly as controls.
  
  
  RESULTS
  One hundred and seventeen (32.4%) HIV-positive TB patients were infected with HBV and/or HCV, compared with 90 (8.9%) HIV-negative TB patients (p=0.000). HIV-positive TB patients had a higher incidence of anti-TB drug-induced hepatotoxicity than HIV-negative TB patients (4.2% vs. 1.0%, odds ratio (OR) 4.348, 95% confidence interval (CI) 1.935-9.769, p=0.000). The incidence of abnormal LFTs in the HIV/TB/HBV group and HIV/TB/HCV group were significantly higher than in the HIV/TB group (40.7% vs. 11.1%, OR 5.525, 95% CI 2.325-13.131, p=0.000; 20.0% vs. 11.1%, OR 2.009, 95% CI 1.057-3.820, p=0.031). A total of 68.4% of patients with HBV-DNA >1.0×10(5) copies/ml and 42.9% of patients with HCV-RNA >1.0×10(5) copies/ml had abnormal LFTs. Twenty-three (19.7%) patients multi-infected with HIV, TB, and hepatitis virus died during anti-TB treatment.
  
  
  CONCLUSIONS
  HIV, HBV, and HCV are risk factors for the development of abnormal LFTs and mortality during anti-TB treatment. TB patients co-infected with HIV and hepatitis virus need close follow-up.
authors.affiliation: Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China.
authors.forename: Pingzheng
authors.initials: P
authors.lastname: Mo
authors.affiliation: Wuhan Tuberculosis Control Center, Hubei, China.
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhu
authors.affiliation: Project HOPE, Millwood, Virginia, USA.
authors.forename: Caroline
authors.initials: C
authors.lastname: Teter
authors.affiliation: Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China.
authors.forename: Rongrong
authors.initials: R
authors.lastname: Yang
authors.affiliation: Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China.
authors.forename: Liping
authors.initials: L
authors.lastname: Deng
authors.affiliation: Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China.
authors.forename: Yajun
authors.initials: Y
authors.lastname: Yan
authors.affiliation: Wuhan Tuberculosis Control Center, Hubei, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Chen
authors.affiliation: Wuhan Tuberculosis Control Center, Hubei, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Zeng
authors.affiliation: Zhongnan Hospital of Wuhan University, Wuhan, Hubei, 430071, China. Electronic address: ZNACT@126.com.
authors.forename: Xi-en
authors.initials: XE
authors.lastname: Gui
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use; D060085:Coinfection / Q000150:complications* / Q000453:epidemiology; D023801:Directly Observed Therapy; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000453:epidemiology; D006509:Hepatitis B / Q000150:complications* / Q000453:epidemiology; D006526:Hepatitis C / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008099:Liver / Q000187:drug effects; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011897:Random Allocation; D012307:Risk Factors; D014376:Tuberculosis / Q000150:complications* / Q000188:drug therapy / Q000401:mortality
chemical_list: D000995:Antitubercular Agents
keywords: HIV; Hepatitis B virus; Hepatitis C virus; Tuberculosis