Reactivación de tuberculosis pulmonar durante el tratamiento con triple terapia de la hepatitis C

Rodríguez-Martín, Laura; Torres, Pedro L. Ballesteros; Cabezudo, Marta Aparicio; Fernández-Fernández, Nereida; Plaza, Francisco Jorquera; Goñi, José Luis Olcoz; Gutiérrez, Esperanza; Morán, Eva

doi:10.1016/j.gastrohep.2015.04.013

Cited by 4 publications

(2 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Therefore, ribavirin stimulates the host adaptive immune response responsible for protection against TB infection and it may act as a protective factor; however, no studies have been specifically performed to prove it. Some other cases of TB infection have also been reported with the triple therapy of pegylated interferon, ribavirin and boceprevir or telaprevir, the first generation of protease inhibitors[ 1 ]. Ledipasvir and sofosbuvir are both DAAs.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Miliary tuberculosis infection during hepatitis C treatment with sofosbuvir and ledipasvir plus ribavirin

Ballester

Martínez

Garcia-Gimeno

et al. 2017

WJH

View full text Add to dashboard Cite

Chronic hepatitis C virus (HCV) infection is one of the main causes of chronic liver disease worldwide. In the last 5 years, treatment for HCV infection has experienced a marked development. In 2014, the use of ledipasvir/sofosbuvir with or without concomitant weight-based ribavirin was approved with a very significant increase in the sustained virological response. However, new side effects have been associated. We report the first case of an HCV infected patient treated for 12 wk with the combination of sofosbuvir/ledipasvir plus ribavirin who developed a miliary tuberculosis (TB) infection while on therapy. The patient was a 65-year-old woman, who referred malaise, asthenia, hyporexia, 7 kg weight loss, productive cough, evening fever and night sweats, right after finishing the treatment. The chest computed tomography-scan revealed a superior mediastinal widening secondary to numerous lymphadenopathies with extensive necrosis and bilateral diffuse lung miliary pattern with little subsequent bilateral pleural effusion, highly suggestive of lymph node tuberculosis with lung miliary spread. A bronchoscopy was performed and bronchial suction showed more than 50 acid-alcohol resistant bacillus per line. A Mycobacterium tuberculosis DNA was detected in blood by polymerase chain reaction, which confirmed the diagnosis of miliary tuberculosis. Some cases of TB infection have been identified with α-interferon-based therapy and with the triple therapy of pegylated interferon, ribavirin and boceprevir or telaprevir. However, significant infection has not been reported with sofosbuvir/ledipasvir plus ribavirin. We believe that the case is relevant to increase awareness of opportunistic infections and particularly TB infection. Although the international guidelines offer no recommendation regarding TB screening, we wonder whether it would be advisable to screen for opportunistic infections prior to the introduction of HCV therapy.

show abstract

Section: Discussionmentioning

confidence: 99%

“…These changes have brought a very significant increase in the SVR, with rates rising above 90%. However, new side effects, such as decompensation of cirrhosis, liver toxicity and some infections, have been associated[ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Miliary tuberculosis infection during hepatitis C treatment with sofosbuvir and ledipasvir plus ribavirin

Ballester

Martínez

Garcia-Gimeno

et al. 2017

WJH

View full text Add to dashboard Cite

show abstract

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

Uehara

Emori

Perez

et al. 2016

The Brazilian Journal of Infectious Diseases

View full text Add to dashboard Cite

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.

show abstract

Reactivation of peritoneal and pleural tuberculosis during hepatitis C treatment with direct-acting antivirals

Pedrosa

Nogales

Vergara

et al. 2019

Gastroenterología y Hepatología (English Edition)

View full text Add to dashboard Cite

Reactivación de tuberculosis pulmonar durante el tratamiento con triple terapia de la hepatitis C

Cited by 4 publications

References 6 publications

Miliary tuberculosis infection during hepatitis C treatment with sofosbuvir and ledipasvir plus ribavirin

Miliary tuberculosis infection during hepatitis C treatment with sofosbuvir and ledipasvir plus ribavirin

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

Reactivation of peritoneal and pleural tuberculosis during hepatitis C treatment with direct-acting antivirals

Contact Info

Product

Resources

About