The role of viral hepatitis B and C in the development of adverse outcomes in patients after tuberculosis

Abstract

Despite the study of the epidemiology of tuberculosis and its co-infection over the past decades, a number of questions remain, including those related to the impact of co-infection on survival depending on the chosen tuberculosis treatment regimen, the likelihood of adverse outcomes in the form of gastrointestinal bleeding and cirrhosis of the liver and their relationship with the therapy of the underlying disease. The purpose of the study: to evaluate the survival of patients with tuberculosis who have co-infection (viral hepatitis B and C) and receive multicomponent chemotherapy. Materials and Methods: The study included all patients who received treatment for active tuberculosis and had viral hepatitis B and/or C from 01/01/2004 to 12/31/2020. A total of 1687 patients were included. Twenty-two patients were lost to follow-up, and attempts to ascertain their clinical status were unsuccessful. Vital status was assessed in all patients. The mean duration of follow-up was 10.5±3.0 years. Median follow-up was 11.3 years (95% confidence interval (CI) 8.2-14.3). The average age of the cohort was 53.3±7.7 years. The study assessed survival and all-cause mortality annually. Results: The frequency of chronic hepatitis B in the group of patients with active tuberculosis was 3.8%, hepatitis C - 14.8%, hepatitis B and C - 0.5% of cases. Such an incidence of viral hepatitis is associated with a high frequency of illicit drug users (62.4%). It should be noted that the frequency of hepatitis treatment was low and amounted to 8.7%. When assessing the contribution of hepatitis B and C to the mortality of patients with active tuberculosis, it was found that hepatitis is not a predictor of death in patients. At the same time, patients who did not receive hepatitis therapy had a higher risk of death (unadjusted odds ratio (OR) - 1.28, 95% CI 1.04-1.65). The adjusted OR for hepatitis B was - 1.87 95% CI 0.67-1.52, C - 1.24 95% CI 0.90-2.18, B and C - 1.72 95% CI 0.99-2.02. Conclusion: The presence of chronic viral hepatitis B and/or C in patients with active tuberculosis did not affect mortality from all causes and regardless of the type of virus during a long period of observation. Patients who did not receive treatment for viral hepatitis and who had a history of tuberculosis had a higher risk of death from all causes (OR 1.28, 95% CI 1.04-1.65).