Viral hepatitis and HIV-associated tuberculosis: Risk factors and TB treatment outcomes in Thailand

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Viral hepatitis and HIV-associated tuberculosis: Risk factors and TB treatment

outcomes in Thailand

The occurrence of tuberculosis (TB), human immunodeficiency virus (HIV), and

viral hepatitis infections in the same patient poses unique clinical and public

health challenges, because medications to treat TB and HIV are hepatotoxic. We

conducted an observational study to evaluate risk factors for HBsAg and/or

anti-HCV reactivity and to assess differences in adverse events and TB treatment

outcomes among HIV-infected TB patients.

Methods: Patients were evaluated at the beginning, during, and at the end of TB

treatment.

Blood samples were tested for aspartate aminotransferase (AST), alanine

aminotransferase (ALT), total bilirubin (BR), complete blood count, and CD4+ T

lymphocyte cell count. TB treatment outcomes were assessed at the end of TB

treatment according to international guidelines.

Results: Of 769 enrolled patients, 752 (98%) had serologic testing performed for

viral hepatitis: 70 (9%) were reactive for HBsAg, 237 (31%) for anti-HCV, and

472 (63%) non-reactive for both markers. At the beginning of TB treatment, 18

(26%) patients with HBsAg reactivity had elevated liver function tests compared

with 69 (15%) patients non-reactive to any viral marker (p=0.02).

At the end of TB treatment, 493 (64%) were successfully treated. Factors

independently associated with HBsAg reactivity included being a man who had sex

with men (adjusted odds ratio [AOR], 2.1; 95% confidence interval [CI], 1.1-4.3)

and having low TB knowledge (AOR, 1.8; CI, 1.0-3.0).

Factors most strongly associated with anti-HCV reactivity were having injection

drug use history (AOR, 12.8; CI, 7.0-23.2) and living in Bangkok (AOR, 15.8; CI,

9.4-26.5). The rate of clinical hepatitis and death during TB treatment was

similar in patients HBsAg reactive, anti-HCV reactive, both HBsAg and anti-HCV

reactive, and non-reactive to any viral marker.

Conclusions: Among HIV-infected TB patients living in Thailand, markers of viral

hepatitis infection, particularly hepatitis C virus infection, were common and

strongly associated with known behavioral risk factors.

Viral hepatitis infection markers were not strongly associated with death or the

development of clinical hepatitis during TB treatment.

Author: Chawin Srinak, Wanitchaya Kittikraisak, Duangporn Pinjeesekikul, Pricha

Charusuntonsri, Phinai Luanloed, La-ong Srisuwanvilai, Sriprapa Nateniyom,

Somsak Akksilp, Sirirat Likanonsakul, Wanchai Sattayawuthipong, Channawong

Burapat and Jay K Varma

_________________________________________________________________

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072008

[Guest guest]

http://7thspace.com/headlines/287208/viral_hepatitis_and_hiv_associated_tubercul\

osis_risk_factors_and_tb_treatment_outcomes_in_thailand.html

Viral hepatitis and HIV-associated tuberculosis: Risk factors and TB treatment

outcomes in Thailand

The occurrence of tuberculosis (TB), human immunodeficiency virus (HIV), and

viral hepatitis infections in the same patient poses unique clinical and public

health challenges, because medications to treat TB and HIV are hepatotoxic. We

conducted an observational study to evaluate risk factors for HBsAg and/or

anti-HCV reactivity and to assess differences in adverse events and TB treatment

outcomes among HIV-infected TB patients.

Methods: Patients were evaluated at the beginning, during, and at the end of TB

treatment.

Blood samples were tested for aspartate aminotransferase (AST), alanine

aminotransferase (ALT), total bilirubin (BR), complete blood count, and CD4+ T

lymphocyte cell count. TB treatment outcomes were assessed at the end of TB

treatment according to international guidelines.

Results: Of 769 enrolled patients, 752 (98%) had serologic testing performed for

viral hepatitis: 70 (9%) were reactive for HBsAg, 237 (31%) for anti-HCV, and

472 (63%) non-reactive for both markers. At the beginning of TB treatment, 18

(26%) patients with HBsAg reactivity had elevated liver function tests compared

with 69 (15%) patients non-reactive to any viral marker (p=0.02).

At the end of TB treatment, 493 (64%) were successfully treated. Factors

independently associated with HBsAg reactivity included being a man who had sex

with men (adjusted odds ratio [AOR], 2.1; 95% confidence interval [CI], 1.1-4.3)

and having low TB knowledge (AOR, 1.8; CI, 1.0-3.0).

Factors most strongly associated with anti-HCV reactivity were having injection

drug use history (AOR, 12.8; CI, 7.0-23.2) and living in Bangkok (AOR, 15.8; CI,

9.4-26.5). The rate of clinical hepatitis and death during TB treatment was

similar in patients HBsAg reactive, anti-HCV reactive, both HBsAg and anti-HCV

reactive, and non-reactive to any viral marker.

Conclusions: Among HIV-infected TB patients living in Thailand, markers of viral

hepatitis infection, particularly hepatitis C virus infection, were common and

strongly associated with known behavioral risk factors.

Viral hepatitis infection markers were not strongly associated with death or the

development of clinical hepatitis during TB treatment.

Author: Chawin Srinak, Wanitchaya Kittikraisak, Duangporn Pinjeesekikul, Pricha

Charusuntonsri, Phinai Luanloed, La-ong Srisuwanvilai, Sriprapa Nateniyom,

Somsak Akksilp, Sirirat Likanonsakul, Wanchai Sattayawuthipong, Channawong

Burapat and Jay K Varma

_________________________________________________________________

Stay in touch when you're away with Windows Live Messenger.

http://www.windowslive.com/messenger/overview.html?ocid=TXT_TAGLM_WL_messenger2_\

072008