Prevalence, drug-induced hepatotoxicity, and mortality among patients multi-infected with HIV, tuberculosis, and hepatitis virus

•TB patients have a higher infection rate of HIV.•HIV-positive TB patients have a higher rate of HCV infection.•HIV, HBV and HCV are risk factors for the development of abnormal LFTs.•Hepatitis viral load is an important predictor for the development of abnormal LFTs.•HIV, HBV and HCV are risk factors for mortality during anti-TB treatment.

SummaryObjectivesTo investigate the prevalence, incidence of abnormal liver function tests (LFTs), and mortality during anti-TB treatment in patients multi-infected with HIV, tuberculosis (TB), and hepatitis virus (hepatitis B virus (HBV) and hepatitis C virus (HCV)).MethodsThree hundred and sixty-one HIV-positive TB patients were enrolled and divided into an HIV/TB group, HIV/TB/HBV group, and HIV/TB/HCV group; 1013 HIV-negative TB patients were selected randomly as controls.ResultsOne hundred and seventeen (32.4%) HIV-positive TB patients were infected with HBV and/or HCV, compared with 90 (8.9%) HIV-negative TB patients (p = 0.000). HIV-positive TB patients had a higher incidence of anti-TB drug-induced hepatotoxicity than HIV-negative TB patients (4.2% vs. 1.0%, odds ratio (OR) 4.348, 95% confidence interval (CI) 1.935–9.769, p = 0.000). The incidence of abnormal LFTs in the HIV/TB/HBV group and HIV/TB/HCV group were significantly higher than in the HIV/TB group (40.7% vs. 11.1%, OR 5.525, 95% CI 2.325–13.131, p = 0.000; 20.0% vs. 11.1%, OR 2.009, 95% CI 1.057–3.820, p = 0.031). A total of 68.4% of patients with HBV-DNA >1.0 × 105 copies/ml and 42.9% of patients with HCV-RNA >1.0 × 105 copies/ml had abnormal LFTs. Twenty-three (19.7%) patients multi-infected with HIV, TB, and hepatitis virus died during anti-TB treatment.ConclusionsHIV, HBV, and HCV are risk factors for the development of abnormal LFTs and mortality during anti-TB treatment. TB patients co-infected with HIV and hepatitis virus need close follow-up.