Viralhepatitisprevalenceinpatientswithactiveandlatenttuberculosis

摘要： AIM:ToassesstheprevalenceofhepatitisBvirus(HBV)andhepatitisCvirus(HCV)infectionandassociationwithdruginducedliverinjury(DILI)inpatientsundergoinganti-tuberculosis(TB)therapy.METHODS:FourhundredandtwentyninepatientswithnewlydiagnosedTB-eitheractivediseaseorlatentinfection-whowereduetocommenceantiTBtherapybetweenSeptember2008andMay2011wereincluded.ThesepatientswereprospectivelytestedforserologicalmarkersofHBV,HCVandhumanimmunodeficiencyvirus(HIV)infections-hepatitisBcoreantigen(HBcAg),hepatitisBsurfaceantigen(HBsAg),hepatitisBeantigen,IgGandIgMantibodytoHBcAg(anti-HBc),HCVIgGantibodyandHIVantibodyusingacombinationofenzyme-linkedimmunosorbentassay,Westernblotassayandpolymerasechainreactiontechniques.PatientswerereviewedatleastmonthlyduringtheTBtreatmentinitiationphase.LiverfunctiontestsweremeasuredpriortocommencementofantiTBtherapyand2-4wklater.Liverfunctiontestswerealsoperformedatanytimethepatienthadsignificantnausea,vomiting,rash,orfeltnon-specificallyunwell.Fishersexacttestwasusedtomeasuresignificanceincomparisonsofproportionsbetweengroups.APvalueoflessthan0.05wasconsideredstatisticallysignificant.RESULTS:Ofthe429patients,270(62.9%)hadactiveTBdiseaseand159(37.1%)hadlatentTBinfection.61(14.2%)patientshadisolatedanti-HBcpositivity,11(2.6%)werealsoHBsAgpositiveand7(1.6%)wereHCV-antibodypositive.16/270patientswithactiveTBdiseasecomparedto2/159patientswithlatentTBinfectionhadmarkersofchronicviralhepatitis(HBsAgorHCVantibodypositive;P=0.023).SimilarlytheproportionofHBsAgpositivepatientsweresignificantlygreaterintheactivevslatentTBinfectiongroup(10/43vs1/29,P=0.04).TheprevalenceofchronicHBVorHCVwassignificantlyhigherthantheestimatedUnitedKingdomprevalenceof0.3%foreach.WefoundnoassociationbetweenDILIandpresenceofserologicalmarkersofHBVorHCV.Three(5.3%)patientswithserologicalmarkersofHBVorHCVinfectionhadDILIcomparedto25(9.5%)patientswithout;P=0.04.CONCLUSION:ViralhepatitisscreeningshouldbeconsideredinTBpatients.DILIriskwasnotincreasedinpatientswithHBV/HCV. ... （共7页）