Viral hepatitis prevalence in patients with active and latent tuberculosis.
OBJECTIVE
To assess the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection and association with drug induced liver injury (DILI) in patients undergoing anti-tuberculosis (TB) therapy.


METHODS
Four hundred and twenty nine patients with newly diagnosed TB - either active disease or latent infection - who were due to commence anti-TB therapy between September 2008 and May 2011 were included. These patients were prospectively tested for serological markers of HBV, HCV and human immunodeficiency virus (HIV) infections - hepatitis B core antigen (HBcAg), hepatitis B surface antigen (HBsAg), hepatitis B e antigen, IgG and IgM antibody to HBcAg (anti-HBc), HCV IgG antibody and HIV antibody using a combination of enzyme-linked immunosorbent assay, Western blot assay and polymerase chain reaction techniques. Patients were reviewed at least monthly during the TB treatment initiation phase. Liver function tests were measured prior to commencement of anti-TB therapy and 2-4 wk later. Liver function tests were also performed at any time the patient had significant nausea, vomiting, rash, or felt non-specifically unwell. Fisher's exact test was used to measure significance in comparisons of proportions between groups. A P value of less than 0.05 was considered statistically significant.


RESULTS
Of the 429 patients, 270 (62.9%) had active TB disease and 159 (37.1%) had latent TB infection. 61 (14.2%) patients had isolated anti-HBc positivity, 11 (2.6%) were also HBsAg positive and 7 (1.6%) were HCV-antibody positive. 16/270 patients with active TB disease compared to 2/159 patients with latent TB infection had markers of chronic viral hepatitis (HBsAg or HCV antibody positive; P = 0.023). Similarly the proportion of HBsAg positive patients were significantly greater in the active vs latent TB infection group (10/43 vs 1/29, P = 0.04). The prevalence of chronic HBV or HCV was significantly higher than the estimated United Kingdom prevalence of 0.3% for each. We found no association between DILI and presence of serological markers of HBV or HCV. Three (5.3%) patients with serological markers of HBV or HCV infection had DILI compared to 25 (9.5%) patients without; P = 0.04.


CONCLUSIONS
Viral hepatitis screening should be considered in TB patients. DILI risk was not increased in patients with HBV/HCV.
Hesam Ahmadi Nooredinvand, Mahmoud Asgheddi, Mohammed Abdullah, Louise Campbell, Shahid A Khan, Hepatology and Gastroenterology Section, Division of Diabetes Endocrinology and Metabolism, Department of Medicine, Imperial College London, W2 1NY London, United Kingdom.
Hesam Ahmadi
HA
Nooredinvand
Hesam Ahmadi Nooredinvand, Mahmoud Asgheddi, Mohammed Abdullah, Louise Campbell, Shahid A Khan, Hepatology and Gastroenterology Section, Division of Diabetes Endocrinology and Metabolism, Department of Medicine, Imperial College London, W2 1NY London, United Kingdom.
David W
DW
Connell
Hesam Ahmadi Nooredinvand, Mahmoud Asgheddi, Mohammed Abdullah, Louise Campbell, Shahid A Khan, Hepatology and Gastroenterology Section, Division of Diabetes Endocrinology and Metabolism, Department of Medicine, Imperial College London, W2 1NY London, United Kingdom.
Mahmoud
M
Asgheddi
Hesam Ahmadi Nooredinvand, Mahmoud Asgheddi, Mohammed Abdullah, Louise Campbell, Shahid A Khan, Hepatology and Gastroenterology Section, Division of Diabetes Endocrinology and Metabolism, Department of Medicine, Imperial College London, W2 1NY London, United Kingdom.
Mohammed
M
Abdullah
Hesam Ahmadi Nooredinvand, Mahmoud Asgheddi, Mohammed Abdullah, Louise Campbell, Shahid A Khan, Hepatology and Gastroenterology Section, Division of Diabetes Endocrinology and Metabolism, Department of Medicine, Imperial College London, W2 1NY London, United Kingdom.
Marie
M
O'Donoghue
Hesam Ahmadi Nooredinvand, Mahmoud Asgheddi, Mohammed Abdullah, Louise Campbell, Shahid A Khan, Hepatology and Gastroenterology Section, Division of Diabetes Endocrinology and Metabolism, Department of Medicine, Imperial College London, W2 1NY London, United Kingdom.
Louise
L
Campbell
Hesam Ahmadi Nooredinvand, Mahmoud Asgheddi, Mohammed Abdullah, Louise Campbell, Shahid A Khan, Hepatology and Gastroenterology Section, Division of Diabetes Endocrinology and Metabolism, Department of Medicine, Imperial College London, W2 1NY London, United Kingdom.
Melissa I
MI
Wickremasinghe
Hesam Ahmadi Nooredinvand, Mahmoud Asgheddi, Mohammed Abdullah, Louise Campbell, Shahid A Khan, Hepatology and Gastroenterology Section, Division of Diabetes Endocrinology and Metabolism, Department of Medicine, Imperial College London, W2 1NY London, United Kingdom.
Ajit
A
Lalvani
Hesam Ahmadi Nooredinvand, Mahmoud Asgheddi, Mohammed Abdullah, Louise Campbell, Shahid A Khan, Hepatology and Gastroenterology Section, Division of Diabetes Endocrinology and Metabolism, Department of Medicine, Imperial College London, W2 1NY London, United Kingdom.
Onn Min
OM
Kon
Hesam Ahmadi Nooredinvand, Mahmoud Asgheddi, Mohammed Abdullah, Louise Campbell, Shahid A Khan, Hepatology and Gastroenterology Section, Division of Diabetes Endocrinology and Metabolism, Department of Medicine, Imperial College London, W2 1NY London, United Kingdom.
Shahid A
SA
Khan
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000995:Antitubercular Agents / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000453:epidemiology; D060085:Coinfection; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis / Q000453:epidemiology*; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D055985:Latent Tuberculosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D008111:Liver Function Tests; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
D000995:Antitubercular Agents; D015415:Biomarkers
Drug induced liver injury; Epidemiology; Hepatitis B; Hepatitis C; Tuberculosis