Prospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2015; 21(29): 8920-8926
Published online Aug 7, 2015. doi: 10.3748/wjg.v21.i29.8920
Viral hepatitis prevalence in patients with active and latent tuberculosis
Hesam Ahmadi Nooredinvand, David W Connell, Mahmoud Asgheddi, Mohammed Abdullah, Marie O’Donoghue, Louise Campbell, Melissa I Wickremasinghe, Ajit Lalvani, Onn Min Kon, Shahid A Khan
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 Connell, Marie O’Donoghue, Melissa I Wickremasinghe, Ajit Lalvani, Onn Min Kon, Tuberculosis Service, St Mary’s Hospital, Imperial College Healthcare NHS Trust, W2 1NY London, United Kingdom
Shahid A Khan, Liver Unit, St Mary’s Hospital, Imperial College London, W2 1NY London, United Kingdom
Author contributions: All authors contributed to this work.
Supported by Grants from the Wellcome Trust; and the Higher Education Funding Council for England.
Conflict-of-interest statement: The authors declare no competing interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Shahid A Khan, BSc, PhD, FRCP, Liver Unit, St Mary’s Hospital, Imperial College London, 10th Floor QEQM Building, South Wharf Road, W2 1NY London, United Kingdom. shahid.khan@imperial.ac.uk
Telephone: +44-203-3126454 Fax: +44-207-4022796
Received: December 22, 2014
Peer-review started: December 23, 2014
First decision: January 27, 2015
Revised: February 23, 2015
Accepted: April 9, 2015
Article in press: April 9, 2015
Published online: August 7, 2015
Processing time: 228 Days and 20.5 Hours
Abstract

AIM: 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.

CONCLUSION: Viral hepatitis screening should be considered in TB patients. DILI risk was not increased in patients with HBV/HCV.

Keywords: Epidemiology; Hepatitis B; Hepatitis C; Tuberculosis; Drug induced liver injury

Core tip: Tuberculosis (TB) patients are not routinely tested for viral hepatitis in the United Kingdom. This is the first study from a European centre investigating the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) in patients with TB. We found that chronic HBV and HCV prevalence in TB patients were 9 and 5 times greater than the estimated United Kingdom prevalence respectively. We also found that a significantly greater proportion of patients with active TB had chronic Hepatitis B compared with patients with latent TB infection. In our study there was no association between drug induced liver injury risk and presence of serological markers of HBV/HCV.