Co-administration of treatment for rifampicin-resistant TB and chronic HCV infection: A TBnet and ESGMYC study

We have been inspired by the report of excellent outcomes of concomitant treatment for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection. 1 Carvalho L. Pillai S. Daniels E. Sellers P. Whyte R. Eveson L. et al. Higher sustained virological response rates at 12 weeks in HIV-HCV co-infection; a tertiary centre experience. J Infect. 2020; 80: 232-254 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar With the present study, we aimed to increase evidence on the optimal management of another common and clinically relevant co-infection, that of HCV and tuberculosis. Chronic HCV-infection affects worldwide 71 million people. 2 WHO, Global Hepatitis Report 2017. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO. Google Scholar Direct-acting antivirals (DAA) revolutionised HCV clinical management since their introduction. Tuberculosis is responsible of 1.4 estimated million deaths per year and multidrug-resistant/rifampicin-resistant tuberculosis (MDR/RR-TB) is a major public health issue worldwide. 3 WHOGlobal Tuberculosis Report 2020. World Health Organization, Geneva2020 Google Scholar Chronic HCV-infection is estimated at 7% among active tuberculosis patients, 4 Behzadifar M. Heydarvand S. Behzadifar M. Bragazzi N.L. Prevalence of hepatitis C Virus in tuberculosis patients: a systematic review and meta-analysis. Ethiop J Health Sci. 2019; 29: 945-956 PubMed Google Scholar reaching up to 30% in some settings among MDR/RR-TB, 5 Seung K.J. Franke M.F. Hewison C. Huerga H. Khan U. Mitnick C.D. High prevalence of hepatitis C infection among multidrug-resistant tuberculosis patients. J Hepatol. 2020; 72: 1028-1029 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar and is associated with liver-related toxicity during anti-tuberculosis treatment. Currently, the World Health Organization (WHO) recommends treating all HCV patients above 12 years with pan-genotypic DAA. 6 WHOGuidelines for the Care and Treatment of Persons Diagnosed with Chronic Hepatitis C Virus Infection. World Health Organization, Geneva2018 Google Scholar Concomitant HCV and rifampicin-susceptible tuberculosis treatment is contraindicated due to drug-drug interactions. Conversely, no interactions are expected between second-line anti-tuberculosis drugs and DAA. 7 Kempker R.R. Alghamdi W.A. Al-Shaer M.H. Burch G. Peloquin C.A. A pharmacology perspective on simultaneous tuberculosis and hepatitis C treatment. Antimicrob Agents Chemother. 2019; ([Internet][cited 2021 Apr 10]; 63Available from:)https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6879218/ Crossref Scopus (8) Google Scholar However, since only limited evidence is available on the co-administration of these drugs, 8 Melikyan N. Huerga H. Atshemyan H. Kirakosyan O. Sargsyants N. Aydinyan T. et al. Concomitant treatment of chronic hepatitis C with direct-acting antivirals and multidrug-resistant tuberculosis is effective and safe. Open Forum Infect Dis. 2021; 8: ofaa653 Crossref PubMed Scopus (2) Google Scholar ,9 Musso M. Mosti S. Gualano G. Mencarini P. Urso R. Ghirga P. et al. Hepatitis C virus infection: a challenge in the complex management of two cases of multidrug-resistant tuberculosis. BMC Infect Dis. 2019; 19: 882 Crossref PubMed Scopus (8) Google Scholar the WHO makes no specific recommendation. 6 WHOGuidelines for the Care and Treatment of Persons Diagnosed with Chronic Hepatitis C Virus Infection. World Health Organization, Geneva2018 Google Scholar The objective of our study was to assess safety and effectiveness of concomitant treatment of chronic HCV-infection and MDR/RR-TB.