The overlapping coinfection of hepatitis B virus and anti-hepatitis C virus antibody in tuberculosis patients: Unraveling co-infection patterns and clinical implications.

Abstract

Aims: Viral hepatitis and tuberculosis are major public health concerns with shared risk factors, especially in marginalized communities. Despite this, routine hepatitis B and C viruses screening in tuberculosis patients is uncommon. This study, conducted in Golestan Province, where tuberculosis and hepatitis B virus have high incidence rates, aimed to assess the rates and prevalence of hepatitis B and anti-hepatitis C viruses testing among active tuberculosis patients.

Materials and methods: Our cross-sectional study was conducted between March 2018 and March 2023 and included patient records of 2283 tuberculosis cases registered in the database of Golestan University of Medical Sciences. Hepatitis B and anti-hepatitis C viruses were tested among patients with confirmed tuberculosis. Clinical and demographic data were collected by taking patient records and performing structured interviews. Exclusions were limited to patients with a confirmed tuberculosis diagnosis. Patients who did not consent to participate and had incomplete information were excluded from the study.

Results: Among 2280 tuberculosis patients, 50.1% were male, with a mean age of 46.22 years. Hepatitis B virus surface antigen was detected in 10.57%, and 2.32% tested positive for anti-hepatitis C virus antibodies. Men were more frequently tested for anti-hepatitis C virus positivity than women (62.15% versus 37.85%, p > 0.3). Most co-infected patients resided in rural areas, with pulmonary tuberculosis being the predominant manifestation. Co-infection rates among chronic hepatitis B virus patients varied by family structure: 6.7% in three-generation families, 15% in two-generation families, and 15% in intrafamilial cases. Additionally, 20% of mother-child pairs and 7.5% of intrafamilial hepatitis B virus patients tested positive for anti-hepatitis C virus. Liver function test abnormalities were more common in hepatitis B virus and tuberculosis patients, especially in hepatitis B/anti-hepatitis C viruses positive tuberculosis cases (p = 0.05). Hepatitis B virus DNA levels were higher in CHB/tuberculosis patients compared to CHB-only patients (p = 0.02).

Conclusions: Tuberculosis patients were more likely to test positive for hepatitis B and anti-hepatitis C viruses than the general population. These results emphasize the need for regular screening and coordinated care for co-infected patients.