Risk factors of hepatitis during Anti-tuberculous treatment and implications of hepatitis virus load

Objectives: Hepatitis during anti-tuberculous treatment (HATT) has been an obstacle in managing patients with tuberculosis (TB). We evaluate the risk factors of HATT and the clinical implications of serum viral loads in those with concomitant hepatitis B or C viruses (HBV/HCV) infection. Methods: We did a prospective study on patients with pulmonary tuberculosis in a medical center. HATT was defined as an increase in serum transaminase level of >3 times the upper limit of normal (ULN) with symptoms, or an increase in serum transaminase level of >5 times ULN without symptoms. Results: 360 TB patients were studied. The prevalence of concomitant HBV and HCV infection was 11.7% and 6.7%, respectively. HATT developed in 68 (18.9%). Cox regression analysis revealed that severe chronic kidney disease without hemodialysis, N-acetyltransferase (NAT2) slow acetylator, high initial HBV/HCV viral load, and women in those without HBV/HCV infection were significant predictors of drug-induced HATT, whereas severe chronic kidney disease without hemodialysis and men with high initial HBV/HCV viral load were significantly associated virus-induced HATT. Conclusion: HBV/HCV viral load interacts with gender and, together with severe chronic kidney disease without hemodialysis and NAT2 slow acetylator, were predictors of HATT. TB patients with these characteristics need close follow-up. (C) 2011 The British Infection Association. Published by Elsevier Ltd. All rights reserved.