Receiving antiviral treatment for hepatitis B (HBV) at the time of tuberculosis (TB) diagnosis reduced hospitalizations as a result of drug-induced liver injury by 56%, indicating that patients with TB and HBV co-infection should be given antiviral treatment for HBV when anti-TB therapy is initiated, according to a study published in Clinical Infectious Diseases.
Chronic HBV infection increases the risk of drug-induced liver injury for patients undergoing anti-TB therapy. This population-level retrospective cohort of patients with TB-HBV co-infection being treated in public Hong Kong hospitals was designed to assess whether antiviral treatment for HBV at the time of TB diagnosis would reduce this risk. The adjusted hazard ratios (aHR) of hospitalization because of drug-induced liver injury within one year in patients who were receiving antiviral treatment at the time of TB diagnosis (categorized by researchers as “patients receiving antiviral therapy”) were determined using a multivariable Cox proportional hazards model adjusting for propensity score.
Four hundred eighty-eight (13.2%) of the 3698 patients with TB-HBV co-infection comprised the cohort of patients receiving antiviral therapy, whereas, the remaining 3210 patients, 446 (13.9%) started antiviral therapy after TB diagnosis. Compared with patients not on antiviral treatment at TB diagnosis, patients receiving antiviral therapy had a lower risk of being hospitalized because of drug-induced liver injury (aHR 0.44; 95% CI, 0.26-0.72), but there were no differences in liver-related mortality between the 2 groups (aHR 0.94; 95% CI, 0.36-2.44) or TB-related mortality (aHR 0.48; 95% CI, 0.15-1.57). Patients receiving antiviral therapy also had a lower risk of hospitalization and of liver-related mortality when compared with patients who started antiviral therapy after TB diagnosis.
Study investigators concluded, “Our cohort study with a large sample size showed that antiviral therapy for HBV given at the time of diagnosis of TB reduced the risk of liver injury in these patients. Based on the results of our study, antiviral therapy for HBV is recommended to be given to patients with TB-HBV co-infection when anti-TB therapy is initiated.”
Multiple study authors report affiliations with pharmaceutical companies. Please see the reference for complete disclosure information.
Lui GCY, Wong NS, Wong RYK, et al. Antiviral therapy for hepatitis B prevents liver injury in patients with tuberculosis and hepatitis B co-infection [published online March 22, 2019]. Clin Infect Dis. doi: 10.1093/cid/ciz241