Co-infection with hepatitis B virus among tuberculosis patients is associated with poor outcomes during anti-tuberculosis treatment

Abstract Background Tuberculosis (TB) and chronic Hepatitis B virus (HBV) infection are common in China. Fist-line anti-TB medications often produce drug-induced liver injury (DILI). This study sought to investigate whether TB patients with chronic HBV co-infection are more susceptible to liver failure and poor outcomes during anti-TB treatment. Methods Eighty-four TB patients developed DILI during anti-TB treatment and were enrolled, including 58 with chronic HBV co-infection (TB-HBV group) and 26 with TB mono-infection (TB group). Clinical data and demographic characteristics were reviewed. The severity of DILI and incidences of liver failure and death were compared. Risk factors of clinical outcomes were defined. Results The patterns of DILI were similar in both groups. Compared with patients in the TB group, patients in the TB-HBV group who did not receive anti-HBV therapy before anti-TB treatment were more susceptible to Grade-4 severity of DILI (36.2% vs. 7.7%, P = 0.005), liver failure (67.2% vs. 38.5%, P = 0.013) and poor outcomes (37.9% vs. 7.7%, P = 0.005). Age > 50 years (48.1% vs. 22.6%, P = 0.049), cirrhosis (50.0% vs. 15.4%, P = 0.046) and total bilirubin > 20 mg/dl (51.6% vs. 14.8%, P = 0.005) were independent risk factors for the rate of death in the TB-HBV group, and HBV DNA > 20,000 IU/ml had borderline significance (44.1% vs. 20.8%, P = 0.081). In the TB-HBV group, nucleos(t)ide analogues as rescue therapy were not able to reduce short-term death (33.3% vs. 36.8%, P = 0.659) once liver failure had occurred. Conclusions Patients on anti-TB therapy with chronic HBV co-infection are more susceptible to developing liver failure and having poor outcomes during anti-TB treatment. Regular monitoring of liver function and HBV DNA level is mandatory. Anti-HBV treatment should be considered in those with high viral levels before anti-TB treatment

Additional file 2: of Co-infection with hepatitis B virus among tuberculosis patients is associated with poor outcomes during anti-tuberculosis treatment

Table S2. Demographics and characteristics of patients in TB-HBV group with different clinical outcomes. Compared with those with better clinical outcomes, the proportions of patients with advanced age (Mean [years]: 53.9 vs. 45.5, P = 0.017; age > 50 years old: 63.6% vs. 36.1%, P = 0.041), severe hyperbilirubinemia (Median of TBIL [μmol/L]: 478.8 vs. 251.0, P = 0.000), cirrhosis (77.3% vs. 41.7%, P = 0.008) and HBV DNA > 20,000 IU/L (77.3% vs. 47.2%, P = 0.024) in the TB-HBV group were significantly higher. (DOCX 22 kb

Additional file 1: of Co-infection with hepatitis B virus among tuberculosis patients is associated with poor outcomes during anti-tuberculosis treatment

Table S1. Demographics and clinical characteristics between TB group and TB-HBVgroup. It showed that more patients in the TB-HBV group experienced severe hyperbilirubinemia (Median of TBIL [μmol/L]: 391.4 vs. 145.8, P = 0.007), cirrhosis (55.2% vs. 7.7%, P = 0.000), Grade-4 DILI (36.2% vs. 7.7%, P = 0.015), liver failure (67.2% vs. 38.5%, P = 0.013) and had poor clinical outcomes (37.9% vs. 7.7%, P = 0.005), compared with those in the TB group. (DOCX 23 kb