The role of hepatitis B infection in anti-tuberculosis drug-induced liver injury: a meta-analysis of cohort studies

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 i...

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Bibliographic Details
Published in:Epidemiology and infection 2020-11, Vol.148, p.e290, Article e290
Main Authors: Zheng, Jing, Guo, Mei-Hong, Peng, He-Wei, Cai, Xiao-Ling, Wu, Yun-Li, Peng, Xian-E
Format: Article
Language:English
Subjects:
Antigens
Antitubercular Agents - adverse effects
Antitubercular Agents - therapeutic use
Chemical and Drug Induced Liver Injury
Cohort analysis
Coinfection
Confidence intervals
Drugs
Health risks
Hepatitis
Hepatitis B
Hepatitis B - complications
Hepatitis B e antigen
Humans
Infections
Injury analysis
Liver
Liver cirrhosis
Meta-analysis
Original Paper
Risk analysis
Tuberculosis
Tuberculosis - complications
Tuberculosis - drug therapy
Viruses
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Summary: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.
ISSN:0950-2688
1469-4409
DOI:10.1017/S0950268820002861