Co-infection of hepatitis C virus infection as determinants of increased hepatotoxicity among tubrculosis patients in Enugu, Nigeria

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Background: Tuberculosis is a devastating disease due to high rate of multidrug resistance. The coinfection with hepatitis C virus (HCV) may enhance the development of hepatotoxicity. There is paucity of data in Nigeria on impact of HCV and TB coinfection. This study was aimed to determine the prevalence of hepatitis C virus in tuberculosis patients and ascertain the association of drug induced hepatotoxicity. Methods & Materials: This is a cross-sectional study that enrolled 148 patients with laboratory confirmed pulmonary tuberculosis between March 2018 and February 2019. The patients were categorized into three groups: group 1, patients that were on DOTS therapy; group 2, those that were newly diagnosed of TB and group 3, those that had completed six months therapy. Information on alcohol intake, cigarette smoking and duration of DOTS (group 1) were obtained. A single blood sample was collected and used for detection of anti-HCV antibodies by recombinant-ELISA, and estimation of Alpha-fetoprotein and liver enzymes. The data obtained were analyzed by chi-square test and the strength of association were measured with logistic regression analysis. Results: The tuberculosis patients comprised of 56.1% (83/148) that were on DOTS, 33.8% (50/148) newly diagnosed and 10.1% (15/148) of those that had completed DOTS, with mean age of 35.7 ± 15.1. The overall prevalence rate of HCV infection in TB patients was 23.6% (35/148). The prevalence of HCV infection in group 1, group 2 and group 3 of the TB patients were 27.7%, 20% and 13.3% respectively. The occurrence of hepatotoxicity, due to increased liver enzymes, was more in patients coinfected with HCV, with 26.5%, 16.0% and 13.3% in group 1, group 2 and group 3 respectively. Severe hepatotoxicity, 2.4%, was observed among the DOTS group. Mild liver inflammation was observed in 18.0% of the TB patients infected with HCV and those not infected were 42.1%, as assessed by alpha-fetoprotein increase >11 ng/ml. The predicting factors for hepatotoxicity were age, alcohol intake and cigarette smoking. Conclusions: The findings in this study showed high prevalence of HCV in TB patients which may complicate the anti-TB drug metabolism in the liver resulting to drug induced hepatotoxicity and liver inflammation.