BMC Infectious Diseases (Oct 2019)

Hepatitis C virus infection: a challenge in the complex management of two cases of multidrug-resistant tuberculosis

  • Maria Musso,
  • Silvia Mosti,
  • Gina Gualano,
  • Paola Mencarini,
  • Rocco Urso,
  • Piero Ghirga,
  • Alessia Rianda,
  • Franca Del Nonno,
  • Delia Goletti,
  • Fabrizio Palmieri

DOI
https://doi.org/10.1186/s12879-019-4494-1
Journal volume & issue
Vol. 19, no. 1
pp. 1 – 4

Abstract

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Abstract 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 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 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.

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