Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, California (Dr Wong); Gastroenterology and Hepatology Section, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California (Dr Wong); Quest Diagnostics, Secaucus, New Jersey (Drs Kaufman and Meyer and Mr Niles); and Tuberculosis Section, Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, San Leandro, California (Dr Chitnis).
J Public Health Manag Pract. 2022;28(5):452-462. doi: 10.1097/PHH.0000000000001536.
Underlying chronic hepatitis B virus (HBV) infection increases the risk of drug-induced liver injury (DILI) when receiving tuberculosis therapies. Prevalence of HBV and latent tuberculosis infection (LTBI) coinfection is not well reported and no studies have evaluated testing patterns for and prevalence of HBV-LTBI coinfection in the United States.
To evaluate patterns of HBV and LTBI testing and prevalence of HBV-LTBI coinfection in the United States.
Retrospective cohort study.
Quest Diagnostics clinical laboratory data, 2014-2020.
Chronic HBV infection was defined as any combination of 2 positive HBV surface antigen, HBV e antigen, or detectable HBV DNA tests at least 6 months apart. LTBI was defined as a positive QuantiFERON-TB or T-SPOT.TB test without evidence of active tuberculosis infection.
Testing patterns for chronic HBV infection and LTBI and prevalence of HBV-LTBI coinfection were evaluated from 2016 through 2020 and stratified by age, sex, and race and ethnicity.
Among 89 259 patients with chronic HBV infection, 9508 (10.7%) were tested for LTBI, among whom prevalence of HBV-LTBI coinfection was 19.6%, more than twice the observed prevalence of LTBI in patients with no chronic HBV infection in our cohort. Among 394 817 LTBI patients, 127 414 (32.3%) were tested for HBV, among whom prevalence of HBV-LTBI coinfection was 1.5%, approximately 3 times higher than prevalence of HBV infection in patients with no LTBI. The HBV-LTBI coinfection prevalence was highest among Asian Americans and older individuals.
The HBV-LTBI coinfection prevalence was likely underestimated because of suboptimal awareness and testing among at-risk populations.
Among US individuals with chronic HBV infection or LTBI, prevalence of HBV-LTBI coinfection is substantial and highlights the need of testing for HBV-LTBI coinfection to mitigate risk of DILI associated with tuberculosis medications in patients with chronic HBV infection.
在接受结核病治疗时，慢性乙型肝炎病毒（HBV）感染会增加药物性肝损伤（DILI）的风险。HBV 和潜伏性结核感染（LTBI）合并感染的患病率尚未得到很好的报道，也没有研究评估过美国 HBV-LTBI 合并感染的检测模式和患病率。
评估美国 HBV 和 LTBI 检测模式以及 HBV-LTBI 合并感染的患病率。
回顾性队列研究。
Quest Diagnostics 临床实验室数据，2014-2020 年。
慢性 HBV 感染定义为至少相隔 6 个月连续 2 次 HBV 表面抗原、HBV e 抗原或可检测 HBV DNA 检测阳性的任意组合。LTBI 定义为阳性 QuantiFERON-TB 或 T-SPOT.TB 检测而无活动性结核感染证据。
从 2016 年至 2020 年评估慢性 HBV 感染和 LTBI 的检测模式以及 HBV-LTBI 合并感染的患病率，并按年龄、性别和种族进行分层。
在 89259 例慢性 HBV 感染患者中，9508 例（10.7%）接受了 LTBI 检测，其中 HBV-LTBI 合并感染的患病率为 19.6%，是我们队列中无慢性 HBV 感染患者中 LTBI 观察到的患病率的两倍多。在 394817 例 LTBI 患者中，127414 例（32.3%）接受了 HBV 检测，其中 HBV-LTBI 合并感染的患病率为 1.5%，约为无 LTBI 患者中 HBV 感染患病率的 3 倍。HBV-LTBI 合并感染的患病率在亚裔美国人和老年人中最高。
由于高危人群的意识和检测不足，HBV-LTBI 合并感染的患病率可能被低估。
在美国慢性 HBV 感染或 LTBI 患者中，HBV-LTBI 合并感染的患病率相当高，这凸显了对 HBV-LTBI 合并感染进行检测的必要性，以降低慢性 HBV 感染患者因结核病药物而发生 DILI 的风险。
