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1.
J Viral Hepat ; 23(12): 1027-1035, 2016 12.
Article in English | MEDLINE | ID: mdl-27624908

ABSTRACT

Occult hepatitis B virus infection (OBI) is characterized by the absence of HBsAg and persistence of the virus genome (HBV-DNA) in liver tissue and/or blood. OBI has been reported in several clinical contexts. However, the clinical significance of OBI in tuberculosis (TB) treatment is unknown. We investigated the OBI prevalence and its impact on the risk of drug-induced liver injury (DILI) during TB treatment. This was a prospective cohort study with one hundred patients who were treated for TB from 2008 to 2015. Laboratory, clinical and demographic data of TB patients were extracted from medical records. Based on HBV-DNA testing of serum samples, an OBI prevalence of 12% was established; almost half of these patients had both anti-HBc and anti-HBs serological markers. Low CD4+ cell counts have been shown to be a risk factor for OBI among TB patients co-infected with HIV (P=.036). High DILI incidence was observed in this study. A multivariable Cox proportional hazard model was conducted and identified OBI (HR 2.98, 95% CI 1.30-6.86) as the strongest predictor for DILI when adjusted to CD4+ cell count (HR 0.38, 95% CI 0.17-0.90), ALT before TB treatment (HR 1.37, 95% CI 0.81-2.32) and TB extrapulmonary clinical form (HR 2.91, 95% CI 1.75-7.21). The main aim of this study was to highlight DILI as a clinical outcome during treatment of TB patients with OBI. Therefore, HBV-DNA testing should be considered routinely in monitoring DILI, and also in other clinical implications associated with OBI, reduce morbidity and mortality.


Subject(s)
Antitubercular Agents/adverse effects , Antitubercular Agents/therapeutic use , Chemical and Drug Induced Liver Injury/epidemiology , DNA, Viral/blood , Hepatitis B, Chronic/complications , Tuberculosis/complications , Adult , Aged , Aged, 80 and over , Female , Hepatitis B Surface Antigens/blood , Hepatitis B, Chronic/pathology , Humans , Male , Middle Aged , Prevalence , Prospective Studies , Tuberculosis/drug therapy , Young Adult
2.
Eur J Clin Microbiol Infect Dis ; 31(6): 965-74, 2012 Jun.
Article in English | MEDLINE | ID: mdl-21901637

ABSTRACT

Most guidelines for Chagas disease recommend the performance of two serological tests in order to detect it. However, inconclusive results may arise from this strategy. The aim was to describe whether serological follow-up together with the patient's clinical characteristics could clarify the outcome of patients with initial inconclusive test results. In this retrospective case series, all results of Chagas disease serological tests and outpatient visits recorded from 2004 to 2008 were screened for inclusion. The inclusion criterion was clinical suspicion of chronic Chagas disease and the exclusion criteria were previous diagnosis of Chagas disease, suspicion of acute Chagas disease, and serological tests with no corresponding medical evaluation. A total of 1,732 patients were analyzed. Chronic Chagas disease prevalence was 21.1%. After the initial set of serological tests, 2.9% of patients had inconclusive test results. Most of these patients had definite diagnosis after clinical follow-up and the repetition of serological tests in a new blood sample. Loss to follow-up while partaking in the diagnostic investigation reached 17.7%. The prevalence of initial inconclusive serological tests for chronic Chagas disease is low. Clinical evaluations and follow-up clarify the definite diagnosis. Noncompliance to follow-up is a frequent problem. Strategies to reduce inconclusive results and noncompliance are discussed.


Subject(s)
Chagas Disease/diagnosis , Parasitology/methods , Adolescent , Adult , Aged , Aged, 80 and over , Chagas Disease/pathology , Child , Child, Preschool , Chronic Disease , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Male , Middle Aged , Retrospective Studies , Serologic Tests/methods , Young Adult
3.
Int J Tuberc Lung Dis ; 14(3): 332-40, 2010 Mar.
Article in English | MEDLINE | ID: mdl-20132625

ABSTRACT

BACKGROUND: Liver toxicity due to tuberculosis (TB) treatment is a frequent cause of treatment interruption, and may sometimes lead to a change in therapy to a less potent regimen. OBJECTIVE: To estimate the risk of hepatotoxicity in patients with or without hepatitis B virus (HBV) infection receiving TB treatment and to develop a clinical prediction rule. DESIGN: A prospective observational follow-up was conducted. Data from 154 patients who underwent TB treatment were analysed. Crude risk ratios were estimated and a Cox proportional hazards model was fit. RESULTS: The mean follow-up time was 187 days. Crude risk ratios showed that ethnicity, human immunodeficiency virus infection, multiple sexual partners, highly active antiretroviral treatment, and clinical forms of TB were possible predictors of liver toxicity. HBV infection and other sexually transmitted diseases showed considerable relative risk, although not statistically significant. The Cox proportional hazards model identified the following predictors of hepatotoxicity: White ethnicity, multiple sexual partners, high baseline alanine transferase and clinical forms of TB. Active HBV, indicated by the detection of surface antigen HBV, could predict hepatotoxicity, although with low precision. CONCLUSION: Using this information, we were able to apply a score and draw a nomogram to estimate survival probabilities and median times to event for each patient.


Subject(s)
Antitubercular Agents/adverse effects , Chemical and Drug Induced Liver Injury/etiology , Hepatitis B/complications , Tuberculosis/drug therapy , Adult , Antiretroviral Therapy, Highly Active/adverse effects , Antiretroviral Therapy, Highly Active/methods , Antitubercular Agents/therapeutic use , Female , Follow-Up Studies , HIV Infections/complications , Humans , Male , Middle Aged , Proportional Hazards Models , Prospective Studies , Racial Groups , Risk Factors , Sexual Partners , Time Factors , Tuberculosis/complications , Tuberculosis/mortality , Young Adult
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