Background: Systematic reviews based on the critical appraisal of observational and analytic studies on HIV prevalence and risk factors for HIV transmission among men having sex with men are very useful for health care decisions and planning. Such appraisal is particularly difficult, however, as the quality assessment tools available for use with observational and analytic studies are poorly established.

In view of the findings that high hepatitis B virus (HBV) deoxyribonucleic acid (DNA) is associated with increased risk of chronic hepatitis B (CHB)-related complications, disease progression in CHB patients in the immune-tolerant phase is uncertain. We evaluated disease progression in 57 immune-tolerant CHB patients with high HBV DNA. Each subject underwent an initial liver biopsy. In those who remained in the immune-tolerant phase, a follow-up liver biopsy was performed after 5 years of follow-up. Patients who developed elevated serum alanine aminotransferase (ALT) levels were discontinued from the study after a follow-up liver biopsy. Traditionally, serum alanine aminotransferase (ALT) level and HBV serology analysis have been widely used for the assessment of patients with CHB infection. The annual incidence of cirrhosis has been estimated to be 2%-6% for hepatitis B e antigen (HBeAg)-positive CHB patients and 8%-10% for HBeAg-negative CHB patients. 4,5 The higher incidence of cirrhosis among HBeAg-negative patients is related to older age and more advanced liver disease at presentation. 2,4,5 More advanced fibrosis stage at presentation correlates with risk of cirrhosis, and those with milder forms of hepatitis have a longer time to cirrhosis. 6 HBeAg positivity has also been found to be associated with higher hepatic inflammation and an increased risk of HCC. Although seroconversion of HBeAg to hepatitis B e antibody (anti-HBe) often leads to hepatic inflammation subsiding and an improved prognosis, the identification of precore/core promoter mutations and recognition of HBeAg-negative CHB disease explain the disease progression noted after HBeAg seroconversion. [7][8][9][10] Recent studies have demonstrated a strong link between viral replication, liver injury, and progression to cirrhosis with increased risk of HCC in CHB-infected From the

Liver toxicity is a common side effect of antituberculosis (anti-TB) drugs. We studied the differences in liver dysfunction observed during anti-TB treatment between hepatitis B virus carriers (HBV) and noncarriers. Three hundred twentyfour patients on anti-TB drugs were recruited and followed up for 1 year. Forty-three patients with HBV and 276 non-HBV patients were included for analysis. Liver function tests and viral markers were monitored monthly. Liver biopsy was requested whenever the alanine transaminase (ALT) was persistently abnormal. Eighty-six HBV carriers who were not given anti-TB drugs were chosen as a second control and evaluated prospectively. The incidence of liver dysfunction was significantly higher in HBV carriers given anti-TB drugs (34.9%) when compared to noncarriers (9.4%, P Ͻ .001) and with HBV carriers not given anti-TB drugs (8.1%, P Ͻ .001). For patients given anti-TB drugs, HBV carriers who developed liver dysfunction were younger (P ϭ .011) and had more severe liver injury compared with noncarriers (P ϭ .008). By multiple logistic regression analysis, age (P ϭ .002) and hepatitis B infection (P Ͻ .001) were the only 2 significant risk factors for hepatotoxicity related to anti-TB therapy. (HEPATOLOGY 2000;31:201-206.)Recently, there has been a resurgence of tuberculosis (TB) in a number of countries. 1,2 It has been estimated that approximately one third of the world' s population is infected with Mycobacterium tuberculosis. This reservoir of infected person results in 8 million new cases of TB and 2.9 million deaths annually. 1 TB and hepatitis B virus (HBV) infection are both endemic in South East Asia. In Hong Kong, the notification rate for TB was 103 persons per 100,000 population in 1996. 3 Approximately 10% of Hong Kong' s population are chronic HBV carriers. 4 Currently, the short-course program for the treatment of TB in Hong Kong begins with a 2-month course of 4 drugs, namely isoniazid, rifampicin, pyrazinamide, and ethambutol. This is followed by a continuation phase of 4 months with the 2 drugs, isoniazid and rifampicin. 3,5,6 Hepatotoxicity is the major adverse effect of isoniazid, rifampicin, and pyrazinamide. 7-10 Chronic hepatitis B 6,11,12 infection has been suggested as a possible risk factor for the development of liver dysfunction caused by anti-TB drugs. 13 However, studies of the effect of chronic hepatitis B carriage on the hepatotoxicity of anti-TB drugs have been unable to show any definite deleterious consequences. 11,14 McGlynn et al. 11 performed a retrospective analysis of isoniazid prophylaxis in 1,833 Asian patients in 1986; Hwang et al. 14 performed a prospective study in 240 Taiwanese patients in 1997. Both studies failed to identify hepatitis B infection as a risk factor for the development of liver dysfunction. None of the studies published to date have assessed the degree of liver damage by histology. There was no attempt made to differentiate between drug-induced damage and damage caused by hepatitis B viral activity. We report a prospective stu...