Study Shows Hep C Infection May Increase TB Incidence

October 24, 2022

Hepatitis C infection may play a role in increased tuberculosis (TB) incidence, according to a recent study led by members of the Emory Tuberculosis Center published in Clinical Infectious Diseases. The study took place in the country of Georgia where an unprecedented nationwide program is taking place to eliminate Hepatitis C through widescale testing and treatment of the whole population.

The researchers pooled data—involving more than 1.8 million adults— from the country of Georgia’s national databases tracking Hep C testing, treatment, and TB disease cases, and found that having untreated hepatitis C infection was associated with a nearly 3-fold increased risk of developing TB disease than those who are not infected with hepatitis C. Further, they showed that among those who had hepatitis C and were cured, the increased risk decreased to 1.6 fold, suggesting that the active hepatitis C infection itself is playing a role in the increased TB disease incidence.

“This study provides the most rigorous examination of the impact of hepatitis C on TB to date and will likely impact international testing and treatment guidelines,” says Neel Gandhi, MD, the senior author on the article. “It will also undoubtedly lead to greater research to examine and understand the immunologic mechanisms that underlie this association.”

Davit Baliashvili, PhD, was lead author on the article, which was part of his PhD dissertation when he was a doctoral student in the Department of Epidemiology at the Rollins School of Public Health.

“Currently, patients with hepatitis C are not considered a high-priority group for TB control, and testing or treatment for latent TB infection is not done among patients with hepatitis C,” says Baliashvili. “Our findings challenge this paradigm and suggest that patients with hepatitis C are at high risk of TB, thus needing more attention in terms of TB prevention efforts.”

While TB transmission and incidence is limited in the United States, TB cases can and still do occur due to reactivation of latent TB infection. Therefore, there is a need to identify groups with a high risk of latent TB reactivation and prioritize them for prevention measures, such as treatment for latent TB infection.

“Our findings suggest that patients with hepatitis C should be considered as one of the high-risk groups for TB control efforts in the U.S.,” says Baliashvili. “There are an estimated 2.5 million people living with hepatitis C in the U.S., so increasing TB screening among this group should be an important part of TB elimination strategies in the U.S.”