Министерство Юстиции
Азербайджанской Республики

High prevalence of hepatitis C among patients with drug-resistant tuberculosis and its impact on the treatment outcome in Azerbaijan prisons (Abstract)

Elmira Gurbanova1,3, Kai Blondal2, Rafail Mehdiyev1, Alan Altraja3,4

1Main Medical Department of the Ministry of Justice of the Republic of Azerbaijan, Baku, Azerbaijan
2Department of Communicable Disease Prevention and Control, Reykjavik Health Care Services, Reykjavik, Iceland
3Department of Pulmonary Medicine, University of Tartu, Tartu, Estonia
4Lung Clinic, Tartu University Hospital, Tartu, Estonia

Introduction: In 2013, 34.7% and 49.7% of new and previously treated pulmonary tuberculosis (TB) patients, respectively, were diagnosed with drug-resistant (DR) TB in Azerbaijan prisons. Although the co-infection with hepatitis C virus (HCV) is frequent among prisoners, the data on HCV prevalence is available only for DR-TB patients. The conclusions on the influence of the HCV on the DR-TB treatment results are contradictory however. 

Aims: To compare the treatment outcome of the DR-TB patients with and without HCV co-infection in the prison setting with low proportion of patients, who are lost to follow-up.

Methods: All patients with DR-TB, who started treatment with second-line anti-TB drugs during the period 2007-2013, were included. All patients had HCV express-test results available at the start of treatment. The individualized treatment regimens in line with the World Health Organization were used. The variables assessed were: treatment outcome, age, BMI, diabetes mellitus, human immunodeficiency virus (HIV), case categories and drug susceptibility testing (DST) results (Table). Treatment success was defined as a sum of cure and treatment completed. Univariate logistic regression was done to assess the impact of the HCV infection to the treatment outcome of DR-TB patients.    

Results: A total of 558 male and 3 female patients were enrolled to the study, of them 62.4% (350) with HCV co-infection. There was no statistically significant difference in treatment outcome among the HCV and non-HCV infected DR-TB patients (Table).

Conclusions: The HCV co-infection had no impact on the treatment outcome of the patients with DR-TB in Azerbaijan prisons.
Table. Characteristics and treatment outcome of DR-TB with or without HCV infection started second-line treatment in Azerbaijan prison, 2007-2013

  HCV infected   Non-HCV infected   P-value
Variable n (mean) % n (mean) %  
Age 38 (18-63)   37 (19-61)   0.399
BMI 19.3 (13-30)   19.6 (13-28)   0.104
New case 72 20.6 45 21.3 -
Retreatment case 278 79.4 166 78.7 0.062
HIV 34 9.7 16 7.6 0.317
Diabetes Mellitus 14 4 7 3.3 0.680
Resistant to RIF only 5 1.4 3 1.4 -
MDR-TB 247 70.6 134 63.5 -
Pre-XDR 43 12.3 30 14.2 0.858
XDR-TB 7 2 4 1.9 -
Total RR-TB 300 85.7 173 81.9 0.241
DR-TB other than RR-TB 50 14.3 38 18.1 -
Treatment success 282 80.8 125 76.3 0.163
Died 18 5.2 13 6.2 0.615
Failed 17 4.9 22 10.4 0.625
Lost to follow up 33 9.2 15 7.1 0.272
BMI=body mass index, DR=drug resistant, MDR-TB=multidrug-resistant tuberculosis, RIF=rifampicin, TB=tuberculosis, RR-TB=rifampicin resistant tuberculosis, XDR-TB=extensively drug-resistant tuberculosis.