Hepatitis C virus infection: a challenge in the complex management of two cases of multidrug-resistant tuberculosis.
Adult
Aged
Antitubercular Agents
/ adverse effects
Antiviral Agents
/ adverse effects
Chemical and Drug Induced Liver Injury
/ enzymology
Female
Hepacivirus
/ genetics
Hepatitis C, Chronic
/ drug therapy
Humans
Italy
Male
RNA, Viral
/ blood
Retreatment
Treatment Outcome
Tuberculosis, Multidrug-Resistant
/ drug therapy
Tuberculosis, Pulmonary
/ drug therapy
Chronic hepatitis C
Drug-induced liver injury
Multidrug-resistant tuberculosis
Treatment
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
22 Oct 2019
22 Oct 2019
Historique:
received:
14
02
2019
accepted:
23
09
2019
entrez:
24
10
2019
pubmed:
24
10
2019
medline:
25
12
2019
Statut:
epublish
Résumé
Multidrug-resistant tuberculosis (MDR-TB) requires lengthy use of second-line drugs, burdened by many side effects. Hepatitis C virus (HCV) chronic infection increases risk of drug-induced liver injury (DILI) in these patients. Data on MDR-TB patients with concurrent HCV chronic infection treated at the same time with second-line antitubercular drugs and new direct-acting antivirals (DAAs) are lacking. We evaluate if treating at the same time HCV infection and pulmonary MDR-TB is feasible and effective. In this study, we described two cases of patients with pulmonary MDR-TB and concurrent HCV chronic infection cured with DAAs at a Tertiary Infectious Diseases Hospital in Italy. During antitubercular treatment, both patients experienced a DILI before treating HCV infection. After DAAs liver enzymes normalized and HCV RNA was undetectable. Then antitubercular regimen was started according to the institutional protocol, drawn up following WHO MDR-TB guidelines. It was completed without further liver side effects and patients were declared cured from both HCV infection and MDR-TB. We suggest to consider treatment of chronic hepatitis C with DAAs as a useful intervention for reintroduction of second-line antitubercular agents in those patients who developed DILI, reducing the risk of treatment interruption when re-exposed to these drugs.
Sections du résumé
BACKGROUND
BACKGROUND
Multidrug-resistant tuberculosis (MDR-TB) requires lengthy use of second-line drugs, burdened by many side effects. Hepatitis C virus (HCV) chronic infection increases risk of drug-induced liver injury (DILI) in these patients. Data on MDR-TB patients with concurrent HCV chronic infection treated at the same time with second-line antitubercular drugs and new direct-acting antivirals (DAAs) are lacking. We evaluate if treating at the same time HCV infection and pulmonary MDR-TB is feasible and effective.
CASES PRESENTATION
METHODS
In this study, we described two cases of patients with pulmonary MDR-TB and concurrent HCV chronic infection cured with DAAs at a Tertiary Infectious Diseases Hospital in Italy. During antitubercular treatment, both patients experienced a DILI before treating HCV infection. After DAAs liver enzymes normalized and HCV RNA was undetectable. Then antitubercular regimen was started according to the institutional protocol, drawn up following WHO MDR-TB guidelines. It was completed without further liver side effects and patients were declared cured from both HCV infection and MDR-TB.
CONCLUSIONS
CONCLUSIONS
We suggest to consider treatment of chronic hepatitis C with DAAs as a useful intervention for reintroduction of second-line antitubercular agents in those patients who developed DILI, reducing the risk of treatment interruption when re-exposed to these drugs.
Identifiants
pubmed: 31640579
doi: 10.1186/s12879-019-4494-1
pii: 10.1186/s12879-019-4494-1
pmc: PMC6806539
doi:
Substances chimiques
Antitubercular Agents
0
Antiviral Agents
0
RNA, Viral
0
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
882Subventions
Organisme : Italian Ministry of Health
ID : Research program no. 4 Tuberculosis, grant Ricerca Corrente IRCCS
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