Antiviral therapy for hepatitis B prevents drug-induced liver injury in patients with tuberculosis and hepatitis B co-infection
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摘要Background: Chronic hepatitis B virus (HBV) infection increases the risk of drug-induced liver injury (DILI) in patients receiving anti-tuberculous therapy. It is uncertain whether antiviral therapy for HBV will reduce the risk of DILI in these patients.
Materials/methods: A territory-wide cohort study was performed to determine the risk of DILI in patients receiving and not receiving antiviral therapy for HBV at the time of diagnosis of tuberculosis (TB). All patients with HBV and TB managed in all public hospitals in Hong Kong from 2001 to 2016 were identified from an electronic database. Patients with underlying cirrhosis, hepatocellular carcinoma, and liver transplant were excluded. Primary outcome was hospitalization for DILI (with a diagnosis of “drug-induced hepatitis/liver derangement”) within one year of diagnosis of TB. Secondary outcome was a composite of hospitalization for DILI or ALT>3 times upper limit of normal within one year of TB diagnosis. Multivariable Cox proportional hazards model was used to determine the hazard ratio of primary and secondary outcomes in patients receiving antiviral therapy for HBV, adjusting for propensity score (for conditional probability of receiving antiviral therapy).
Results: A total of 3698 patients with HBV-TB co-infection were identified (mean age 56±17 years, 74% male). 488 (13.2%) patients received antiviral therapy for a median of 472 (IQR 65,1347) days (entecavir 45%, lamivudine 30%, tenofovir 28%, adefovir 2%). They were younger, had more concomitant liver diseases other than HBV (including hepatitis C, fatty liver, alcoholic liver disease), higher albumin level, and lower platelet count (all p<0.005) than those not receiving antivirals.
Cumulative incidence of primary outcome was 4.1% and 8.9% (p=0.009), and that of secondary outcome was 19.5% and 20.3% (p=0.878) in those receiving and not receiving antiviral respectively.
Multivariable model showed use of antiviral therapy had lower risk of hospitalization for DILI with adjusted hazard ratio (aHR) 0.437 (95%CI 0.265-0.722, p=0.001) and lower risk of secondary outcome (aHR 0.758; 95%CI 0.583-0.985, p=0.038) (Figure).
Conclusions: Antiviral therapy for HBV for patients with newly diagnosed TB may reduce the risk of DILI. Prospective randomized trials to determine routine use of antiviral therapy for patients with HBV-TB co-infection are warranted.
著者Lui G, Wong NS, Wong VWS, Wong RYK, Tse YK, Yung IMH, Chan WL, Chan HLY, Wong GLH
會議名稱28th European Congress of Clinical Microbiology and Infectious Diseases - ECCMID 2018

上次更新時間 2018-23-10 於 17:26