High incidence of tuberculosis in patients treated for hepatitis C chronic infection

Abstract

Brazil is one of the 22 countries that concentrates 80% of global tuberculosis cases concomitantly to a large number of hepatitis C carriers and some epidemiological risk scenarios are coincident for both diseases. We analyzed tuberculosis cases that occurred during α-interferon-based therapy for hepatitis C in reference centers in Brazil between 2001 and 2012 and reviewed their medical records. Eighteen tuberculosis cases were observed in patients submitted to hepatitis C α-interferon-based therapy. All patients were human immunodeficiency virus-negative. Nine patients (50%) had extra-pulmonary tuberculosis; 15 (83%) showed significant liver fibrosis. Hepatitis C treatment was discontinued in 12 patients (67%) due to tuberculosis reactivation and six (33%) had sustained virological response. The majority of patients had a favorable outcome but one died. Considering the evidences of α-IFN interference over the containment of Mycobacterium tuberculosis, the immune impairment of cirrhotic patients, the increase of tuberculosis case reports during hepatitis C treatment with atypical and severe presentations and the negative impact on sustained virological response, we think these are strong arguments for latent tuberculosis infection screening before starting α-interferon-based therapy for any indication and even to consider IFN-free regimens against hepatitis C when a patient tests positive for latent tuberculosis infection.

Prevalence of Mycobacterium tuberculosis Infection in Suspected Patients in a Teaching Hospital in Northeastern Iran: A Cross-Sectional Study

“…The disease is a leading cause of mortality worldwide. TB is one of the immediate priorities of the World Health Organization (WHO), especially in countries with a low socioeconomic status (de Oliveira Uehara et al, 2016;Viney et al, 2015).…”

Latent tuberculosis infection screening in HCV patients: The necessity and guidelines for Pakistan

“…Other vulnerable groups are patients under treatment for rheumatoid arthritis, inflammatory bowel disease, kidney disease, diabetes and individuals with organ transplant [2]. Recently, it has been highlighted that there is higher TB incidence in patients treated for HCV infection [3]. In this report, analysis was done on TB incidence during interferon-based treatment for hepatitis C. The data showed that most of the HCV positive patients (89%) were treated with double therapy, i.e.…”

“…genotype 3. As interferon based treatment could leads to TB reactivation, the higher burden of TB in Pakistan might be explained by de Oliveira Uehara et al [3]. In 2009, Pakistan ranks 8th in the world in term of TB burden and share about 44% of tuberculosis burden in the Eastern Mediterranean region [9].…”

Avaliação do risco e causas de óbito entre indivíduos diagnosticados com hepatite C através de exames de triagem para doação de sangue, no período de 1994 a 2016, em um hemocentro de São Paulo-SP

“…Dessa forma, esses dados demonstram a importância de se buscar a presença de distúrbios psiquiátricos entre indivíduos infectados pelo vírus da hepatite C, para que assim possam ser trabalhadas medidas de prevenção para eventos que podem, como visto, levarem a um incremento da morbimortalidade.No presente estudo, as infecções estiveram associadas a um risco quase três vezes maior de morte em indivíduos positivos para o HCV. Uma associação entre a infecção pelo HCV e risco aumentado para infecções bacterianas já foi relatada anteriormente[122][123][124][125][126] . Tuberculose, pneumonia adquirida na comunidade ou infecções bacterianas entre pacientes em hemodiálise são muito mais frequentes em indivíduos infectados pelo HCV[122][123][124][125][126] .…”

“…Uma associação entre a infecção pelo HCV e risco aumentado para infecções bacterianas já foi relatada anteriormente[122][123][124][125][126] . Tuberculose, pneumonia adquirida na comunidade ou infecções bacterianas entre pacientes em hemodiálise são muito mais frequentes em indivíduos infectados pelo HCV[122][123][124][125][126] . A coinfecção com o HIV e o uso de drogas injetáveis também são mais comuns em pacientes infectados pelo HCV e podem levar a maiores taxas de mortalidade por sepse15 .…”