The role of chronic viral hepatitis on tuberculosis treatment interruption

• Published in: The international journal of tuberculosis and lung disease Vol. 22; no. 12; pp. 1486 - 1494
• Main Authors: Chua, A. P-G., Lim, L. K-Y., Gan, S-H., Chee, C. B-E., Wang, Y-T.
• Format: Journal Article
• Language: English
• Published: France International Union Against Tuberculosis and Lung Disease 01.12.2018; International Union against Tuberculosis and Lung Disease (IUATLD)
• Subjects: Chronic infection; Drug-Induced Liver Injury; Hepatic Flares; Hepatitis; Hepatitis B; Hepatitis C; Infections; Interruption; Liver; Liver diseases; Medical treatment; Patients; Pyrazinamide; Regression analysis; Tuberculosis; Viruses; Singapore
• ISSN: 1027-3719; 1815-7920
• DOI: 10.5588/ijtld.18.0195

BACKGROUND: Tuberculosis (TB) drug-induced liver injury (TB-DILI) usually occurs within 8 weeks of anti-tuberculosis drug initiation. In Singapore, we suspected that the onset of TB drug-induced transaminitis may be confounded with hepatitis C virus (HCV) and hepatitis B (HBV) virus co-infection.OBJECTIVE: To determine the impact of HCV/HBV co-infection on the course of treatment in patients with TB treatment interrupted due to transaminitis.DESIGN: TB patients with treatment interruption during 2013-2014 were identified through the Singapore national TB registry. Case notes of those with transaminitis were perused.RESULTS: Of 3860 TB patients notified, 140 had suspected TB-DILI. Of these, respectively 20/140 (14.3%) and 16/140 (11.4%) were HCV- or HBV-positive. The median time to treatment interruption/transaminitis was 5 weeks vs. 9.9 weeks and 9.6 weeks for transaminitis patients without chronic liver disease and with HCV/HBV co-infection (P < 0.01). Multivariate logistic regression analysis revealed that having HCV/HBV co-infection was associated with treatment interruption occurring beyond 8 weeks (adjusted OR [aOR] 4.06, 95%CI 1.28-12.85); HCV transaminitis patients were more likely to take 10 months to complete anti-tuberculosis treatment (aOR 5.11, 95%CI 1.21-21.67) than those without chronic liver disease.CONCLUSION: TB treatment interruption due to transaminitis in HCV/HBV co-infected patients occurred later than in those without liver disease. Most had completed 2 months of pyrazinamide-containing intensive phase treatment before the onset of transaminitis.