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Abstract
Objective Coinfection of tuberculosis (TB) and viral hepatitis may increase the risk of antituberculosis treatment-induced hepatotoxicity, which is regarded as a common cause of termination of the first-line antituberculosis drugs. The study aimed at investigating the protective effects of antiviral therapy on the liver and innate immunity in patients with TB-HBV coinfection. Methods A total of 100 patients with TB-HBV coinfection were recruited and split into antituberculosis and antiviral groups, 50 per group, according to odd or even date of hospital admission from December 2019 to October 2020. The patients in the anti-TB group received antituberculosis therapy, and those in the antiviral group received antiviral therapy. The clinical effectiveness; HBV-DNA negative conversion rate; liver function assessment involving alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBIL); immune function evaluation including CD4+, CD8+, CD4+/CD8+, and CD3+ T cells; inflammatory cytokines containing tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interferon-γ (IFN-γ); and intestinal microflora including bifidobacterium, lactobacillus, enterobacterium, enterococcus, and clostridium were main outcome measures after treatment. Results It was found that the total response rate in the antiviral group was significantly higher than the anti-TB group after treatment (χ2 = 3.157, P=0.017). There was a significant difference in HBV-DNA negative conversion rates between the antiviral group and anti-TB group (82% vs. 58%, χ2 = 6.384, P=0.001). The ALT, AST, and TBIL in the two groups were all increased after treatment (P < 0.05), but the antiviral group indicated a rise of the above indices compared to the anti-TB group (P < 0.05). The two groups showed a rise on the concentration of CD3+, CD4+, and CD4+/CD8+ T cells and a decline on the CD8+ T cells after treatment (P < 0.05), but these changes in the antiviral group were more evident to those in the anti-TB group (P < 0.05). There was an increase on the IFN-γ level and decrease on the TNF-α and IL-6 levels in both groups after treatment (P < 0.05), but the antiviral group revealed a higher level of IFN-γ with lower levels of TNF-α and IL-6 compared to the anti-TB group (P < 0.05). After treatment, the number of bifidobacteria and lactobacilli was increased, and the number of enterobacteria, enterococci, and clostridium were decreased in the two groups (P < 0.05), while these changes in the antiviral group were more remarkable compared to the anti-TB group (P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups (χ2 = 0.267, P=0.731). Conclusion Antiviral therapy for tuberculosis-HBV coinfected patients could inhibit HBV replication, providing protection against liver damage, improving innate immunity, and balancing intestinal microflora.
Highlights
Treatment, or after treatment, the viral biomarkers were closely related to the diagnosis of chronic hepatitis B virus (HBV) infection [9]. e main HBV biomarkers consist of serology and molecular methods. e serology involves the detection and quantification of hepatitis B surface antigen (HBsAg), and the molecular methods were applied to detect the quantification of HBV-deoxyribonucleic acid (DNA) [10]. e chronic HBV infection has been contributed to the major threat of global public health and economy burden [11]. e first effective vaccine against HBV was available in 1981 but with limited use in the infants who was born in low-income and middle-income countries due to its high cost [12, 13]
A total of 100 patients with TB-HBV coinfection were recruited and split into antituberculosis and antiviral groups, 50 per group, according to odd or even date of hospital admission from December 2019 to October 2020. e antituberculosis treatment was applied to the patients in the anti-TB group, and the patients in the antiviral group received additional antiviral therapy on the basis of antituberculosis treatment. e anti-TB group included 31 males and 19 females who aged from 22 to 65 years, with an average age of 40.15 ± 16 years
Chronic hepatitis B is a potentially life-threatening liver infection caused by the HBV, which is a well-known threat to global health [19]. e World Health Organization (WHO) estimated that, in 2015, chronic HBV attacked more than 2 billion individuals, with the result of 887.000 deaths caused mostly by cirrhosis and hepatocellular carcinoma [20, 21]. e US Food and Drug Administration has approved two types of medicines for chronic HBV treatment
Summary
Tuberculosis (TB) and chronic hepatitis B virus (HBV) are common diseases all over the world, which cause huge burden on global health care [1, 2]. Evidence-Based Complementary and Alternative Medicine of the world’s population runs the risk of being potentially infected with tuberculosis every year [4], and TB, as one of the top 10 causes of death, was associated with 1.37 million deaths estimated by the WHO in 2015, which was comparable with that of chronic HBV and chronic hepatitis C virus (HCV) [5]. E virus hepatitis mostly involving chronic HBV and HCV leaded to 1.34 million deaths, and the cirrhosis and hepatocellular carcinoma were responsible for the major causes of deaths [5]. We aimed at finding out the changes of liver function, HBV-DNA, immune system, inflammatory response, and intestinal microflora in patients with TB-HBV coinfection, who received the additional antiviral therapy
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