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

Chawin Sirinak¹ , Wanitchaya Kittikraisak² , Duangporn Pinjeesekikul¹ , Pricha Charusuntonsri¹ , Phinai Luanloed¹ , La-ong Srisuwanvilai¹ , Sriprapa Nateniyom³ , Somsak Akksilp⁴ , Sirirat Likanonsakul⁵ , Wanchai Sattayawuthipong⁶ , Channawong Burapat² and Jay K Varma²^,7

¹Department of Health, Bangkok Metropolitan Administration, Bangkok, Thailand

²Thailand Ministry of Public Health – U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand

³Thailand Ministry of Public Health, Nonthaburi, Thailand

⁴Office of Disease Prevention and Control 7, Ubon-ratchathani, Thailand

⁵Bamrasnaradura Infectious Diseases Institute, Nonthaburi, Thailand

⁶Phuket Provincial Health Office, Phuket, Thailand

⁷U.S. Centers for Disease Control and Prevention, Atlanta, USA

author email corresponding author email

BMC Public Health 2008, 8:245doi:10.1186/1471-2458-8-245


Published:	18 July 2008

Abstract

Background

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.

Conclusion

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.