Abstract
Drug-induced liver injury (DILI) is a common adverse drug reaction leading to the interruption of tuberculosis (TB) therapy. We aimed to identify whether the hepatitis B virus (HBV) infection would increase the risk of DILI during first-line TB treatment. A meta-analysis of cohort studies searched in PubMed, Web of Science and China National Knowledge Infrastructure was conducted. Effect sizes were reported as risk ratios (RRs) and 95% confidence intervals (CIs) and calculated by R software. Sixteen studies with 3960 TB patients were eligible for analysis. The risk of DILI appeared to be higher in TB patients co-infected with HBV (RR 2.66; 95% CI 2.13-3.32) than those without HBV infection. Moreover, patients with positive hepatitis B e antigen (HBeAg) were more likely to develop DILI (RR 3.42; 95% CI 1.95-5.98) compared to those with negative HBeAg (RR 2.30; 95% CI 1.66-3.18). Co-infection with HBV was not associated with a higher rate of anti-TB DILI in latent TB patients (RR 4.48; 95% CI 0.80-24.99). The effect of HBV infection on aggravating anti-TB DILI was independent of study participants, whether they were newly diagnosed with TB or not. Besides, TB and HBV co-infection patients had a longer duration of recovery from DILI compared to non-co-infected patients (SMD 2.26; 95% CI 1.87-2.66). To conclude, the results demonstrate that HBV infection would increase the risk of DILI during TB therapy, especially in patients with positive HBeAg, and close liver function monitoring is needed for TB and HBV co-infection patients.
Highlights
Tuberculosis (TB) is a chronic communicable disease caused by Mycobacterium tuberculosis
On analysing the pooled effect size from 16 studies, the risk of drug-induced liver injury (DILI) appeared to be higher in TB patients co-infected with hepatitis B virus (HBV) than those without HBV infection
Four studies reported that the duration of recovery from DILI was longer in HBV co-infected patients, indicating that HBV carriers might develop DILI more severely
Summary
Tuberculosis (TB) is a chronic communicable disease caused by Mycobacterium tuberculosis. Among single infectious pathogen illnesses, a high proportion of deaths results from TB, which remains a threatening public health issue worldwide [2, 3]. As a recommended anti-TB strategy, short-course first-line medication regimens have been proved to be effective [1]. Isoniazid is of great importance to kill bacilli during the early anti-TB period. With the addition of pyrazinamide, the sterilizing effect gets better [4, 5]. Drug-induced liver injury (DILI) associated with the above medications is a common adverse drug reaction. Hepatotoxicity is likely to develop further severely when used in combination, especially on the addition of pyrazinamide [7,8,9]. Anti-TB DILI would result in the interruption of chemotherapy regimens and even cause death
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