title: High incidence of tuberculosis in patients treated for hepatitis C chronic infection.
abstract: Brazil is one of the 22 countries that concentrates 80% of global tuberculosis cases concomitantly to a large number of hepatitis C carriers and some epidemiological risk scenarios are coincident for both diseases. We analyzed tuberculosis cases that occurred during α-interferon-based therapy for hepatitis C in reference centers in Brazil between 2001 and 2012 and reviewed their medical records. Eighteen tuberculosis cases were observed in patients submitted to hepatitis C α-interferon-based therapy. All patients were human immunodeficiency virus-negative. Nine patients (50%) had extra-pulmonary tuberculosis; 15 (83%) showed significant liver fibrosis. Hepatitis C treatment was discontinued in 12 patients (67%) due to tuberculosis reactivation and six (33%) had sustained virological response. The majority of patients had a favorable outcome but one died. Considering the evidences of α-IFN interference over the containment of Mycobacterium tuberculosis, the immune impairment of cirrhotic patients, the increase of tuberculosis case reports during hepatitis C treatment with atypical and severe presentations and the negative impact on sustained virological response, we think these are strong arguments for latent tuberculosis infection screening before starting α-interferon-based therapy for any indication and even to consider IFN-free regimens against hepatitis C when a patient tests positive for latent tuberculosis infection.
authors: Gastroenterology Division, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, SP, Brazil. Electronic address: siuehara@gmail.com.
authors: Silvia Naomi
authors: SN
authors: de Oliveira Uehara
authors: Gastroenterology Division, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, SP, Brazil.
authors: Christini Takemi
authors: CT
authors: Emori
authors: Internal Medicine Department, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil.
authors: Renata Mello
authors: RM
authors: Perez
authors: Infectious Disease Division, Universidade de São Paulo (USP), Sao Paulo, SP, Brazil.
authors: Maria Cassia Jacintho
authors: MC
authors: Mendes-Correa
authors: Gastroenterology Division, Universidade Federal do Maranhão (UFMA), Sao Luis, MA, Brazil.
authors: Adalgisa
authors: A
authors: de Souza Paiva Ferreira
authors: Gastroenterology Division, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, SP, Brazil.
authors: Ana Cristina
authors: AC
authors: de Castro Amaral Feldner
authors: Gastroenterology Division, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, SP, Brazil.
authors: Antonio Eduardo Benedito
authors: AE
authors: Silva
authors: Gastroenterology Division, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, SP, Brazil.
authors: Roberto José Carvalho
authors: RJ
authors: Filho
authors: Gastroenterology Division, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, SP, Brazil.
authors: Ivonete Sandra
authors: IS
authors: de Souza E Silva
authors: Gastroenterology Division, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, SP, Brazil.
authors: Maria Lucia Cardoso Gomes
authors: ML
authors: Ferraz
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001938:Brazil / Q000453:epidemiology; D060085:Coinfection / Q000453:epidemiology; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016898:Interferon-alpha / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014376:Tuberculosis / Q000453:epidemiology* / Q000276:immunology
chemical_list: D000998:Antiviral Agents; D016898:Interferon-alpha
keywords: Alpha-interferon; Hepatitis C; Latent tuberculosis infection; Tuberculosis