D0504 - Prevalence of Hepatitis B Virus (HBV) and Latent Tuberculosis Co-Infection and Risk of Drug-Induced Liver Injury Across Two Large HBV Cohorts in the United States

Introduction: Screening for hepatitis B virus (HBV) infection prior to starting tuberculosis (TB) treatment is important because HBV-TB co-infected patients have increased risk of drug-induced liver injury (DILI). However, there are limited real-world data on epidemiology of HBV-latent TB infection (LTBI) in the US. We evaluated prevalence and predictors of HBV-LTBI co-infection and DILI risk among two distinct US chronic HBV cohorts.

Methods: Adults with chronic HBV from 2010–2020 were identified among the Chronic Hepatitis Cohort Study (CHeCS) and the Veterans Affairs national chronic HBV cohort (VA-HBV). HBV-LTBI co-infection was identified based on laboratory data (TB-Quantiferon), ICD-9/10 codes, and prescription data. DILI was identified based on established definitions that incorporated ICD-9/10 codes and changes in alanine aminotransferase levels following start of LTBI treatment.

Results: Among 6,019 chronic HBV patients in the CHeCS cohort (44% female; 47% age 18-39y, 39% age 40-59y, 14% age >60y; 47% Asian, 20% non-Hispanic white (NHW), 14% African American (AA), 1% Hispanic; 3% HCV; 6% HIV), 9.1% were tested for TB, among which 7.7% had HBV-LTBI. Significantly higher odds of HBV-LTBI were observed in women vs. men (13% vs. 5%, OR 2.57, 95% CI 1.36-4.85 p< 0.01), but no other significant differences were observed. Among HBV-LTBI patients that received LTBI treatment, 28.6% developed DILI. Among 12,928 predominantly U.S.-born chronic HBV patients in the VA-HBV cohort (94% male; 6% age 18-39y, 30% age 40-59y, 65% age >60y; 10% Asian, 42% AA, 39% NHW, 2% Hispanic; 86% US-born; 15% HCV; 2.3% HIV), 14.7% were tested for TB, among which 14.5% had HBV-LTBI. Significantly higher odds of HBV-LTBI were observed in AA vs. NHW (15% vs. 12%, OR 1.70, 95% CI 1.18-2.43, p< 0.01) and in non-US born vs. US-born (25% vs. 13%, OR 2.13, 95% CI 1.34-4.00, p< 0.05). Among HBV-LTBI patients that received LTBI treatment, the proportion of patients that developed DILI was 3.6%.

Discussion: Among two large distinct US cohorts of chronic HBV patients, testing for LTBI was infrequent despite relatively high prevalence of HBV-LTBI. While nearly 30% of HBV-LTBI patients in the predominantly Asian and younger CHeCS cohort developed DILI, only 3.6% in the predominantly older, US born VA-HBV cohort developed DILI. Better understanding risk factors for DILI among HBV-LTBI patients can help guide clinicians to appropriately modify LTBI treatment to reduce DILI risk. Supported by ACG Clinical Research Award.