Analysis associated with nearly 23 million lab tests finds only 1 in 3 patients with latent tuberculosis were also tested for chronic hepatitis B, despite similar risk factors within patients
Findings heighten caution about use of tuberculosis therapies, which raise danger of liver injury in patients co-infected with chronic hepatitis B virus
SECAUCUS, N. J. , July 25, 2022 /PRNewswire/ — Concurrent testing for persistent hepatitis W (HBV) plus tuberculosis (TB) occurs inside a minority of patients who test positive with regard to either condition, despite similar risk profiles and, for some, risk of TB therapy-induced liver damage, according to a new Quest Diagnostics Health Trends® study published in the Journal associated with Public Wellness Management & Practice .
The study was conducted by researchers from Mission Diagnostics (NYSE: DGX ), Stanford University School of Medicine and the Veterans Affairs Palo Alto Health Care System in Palo Alto, Calif. Based on analysis of results of 17, 635, 261 deidentified laboratory tests regarding hepatitis and 5, 205, 393 tests for TB performed by Quest Analysis between 2016 and 2020, the study is the most comprehensive assessment associated with testing patterns and prevalence estimates of these two infectious diseases. Existing research to date is limited simply by small research size plus decades-old data.
The experts evaluated deidentified data from HBV surface antigen (HBsAg) and core antibody total (HBcAb) assessments as well as the particular QuantiFERON ® and T-SPOT ® . TB series of Interferon Gamma Release Assay (IGRA) blood checks to assess latent TB infection. IGRA tests are guideline recommended for many patients plus generally considered more efficient and accurate than skin prick tests, which usually require multiple doctor’s appointments[i][ii][iii].
Latent TB infection was defined as having either a positive QuantiFERON or T-SPOT ® test along with no positive results for Mycobacterium tuberculosis (MTB) complex or mycobacterial culture during the study period (as that would indicate active TB infection). The QuantiFERON or even T-SPOT ® testing do not differentiate between active plus latent.
Among individuals tested intended for both infections, nearly one in 5 (19. 6%) with chronic hepatitis M also have latent TB, more than twice the TB positivity of patients without chronic hepatitis B (7. 3%). Among patients tested for both, the positivity rate to get chronic hepatitis B among those latent TB positive was three times higher than pertaining to patients found not to have latent TB (1. 5% versus 0. 5%).
Among the study’s most significant findings is that only one within three (32. 3%) sufferers who tested positive meant for latent TB was furthermore tested designed for HBV infection. Commonly used TB treatments can cause liver organ injury if administered in order to patients who are also co-infected with HBV. The study also found that will only 10. 7% associated with chronic HBV patients were also examined for latent TB.
The particular authors of the research wrote that the prevalence associated with co-infection is “substantial” and highlights the need to test just for co-infection “to mitigate risk of drug-induced liver injury associated with TB medications in patients with concurrent chronic HBV. ”
According to lead author Robert Wong , M. D., Clinical Associate Professor, Stanford University , “This study is the particular first large scale analysis to my knowledge of coinfection of TB and HBV, two prevalent and under-screened and under-treated infectious diseases in the United States . Timely identification of underlying hepatitis B co-infection can help guide modification of TB treatments regimens with lower risk associated with drug-induced liver injury. This analysis identified an important gap in TB management plus suggests the need for the purpose of quality improvement initiatives to ensure routine HBV screening in TB patients prior to start of treatment. inch
Other findings showed that concurrent testing rose along with increasing age, from 7. 2% in patients younger than 18 years in order to 29. 5% in those greater compared to 70 years. When evaluating by race/ethnicity, the highest rate of latent TB testing was observed among Black/African American individuals, whereas the particular highest frequency of HBV-latent TB co-infection was observed in Asian American patients, at 2. 7% (based about race/ethnicity estimates drawn through 3-digit Zip codes). In addition , the study observed higher rates associated with co-infection inside parts of southern California , the San Francisco Bay Area , and the southern part of Nevada , compared to the rest of the United States .
“Our nationally representative research provides important novel insights into the scale of coinfection associated with both latent TB and HBV, ” said co-author Harvey W. Kaufman , M. Deb., Senior Medical Director plus Director of the Wellness Trends research program for Quest Diagnostics. “It also provides essential insight into demographic and regional designs that may help guide public health and clinical decision making. ”
The Centers with regard to Disease Control and Prevention (CDC) estimations that there are 862, 000 people living with persistent HBV contamination in the United States.[iv] The particular CDC furthermore estimates that will there had been 7, 860 reported TB cases in the United States in 2021, although as numerous as 13 million individuals, many born outside the usa , have latent TB infection.[v] Latent TB plus chronic HBV both often lack symptoms, and, in some patients, may progress in order to acute disease, causing liver organ damage or failure. Delays in diagnosis and treatment for latent TB and chronic HBV are associated with significant morbidity and mortality, and result in 7 plus 14 many years per life lost, respectively.
The CDC also notes that rates of new HBV infections are highest among adults aged 40-49 years, reflecting low hepatitis B vaccination coverage among adults. HBV infection is related to intravenous drug use related to the particular opioid crisis, incarceration, homelessness and other social determinants associated with health. Given comparatively high rates of infection within much of Asia , individuals of Asian descent inside america are usually also more likely to be infected with chronic HBV even without other risk factors, according to the CDC.
The study’s strengths include national scale and outcomes of quality lab testing methods. Weaknesses consist of lack associated with medication and other medical data to identify patterns in treatment.
About Pursuit Diagnostics Health Trends ™
Quest Analysis Health Trends™ is a series of scientific reports that provide insights in to health topics, based on evaluation of objective clinical laboratory data, in order to empower better patient care, population wellness management plus public health policy. The reports are based on the Search Diagnostics database of 60 billion de-identified laboratory check results, believed to be the largest of its kind in healthcare. Health Trends has yielded novel information to aid the management of allergies and asthma, prescription drug monitoring, diabetes, Lyme illness, heart disease, influenza and workplace wellness. Goal Diagnostics also produces the Drug Testing Index (DTI)™, a number of reviews on national workplace medication positivity trends based on the company’s employer place of work drug screening data. https://newsroom.questdiagnostics.com/health-trends
About Quest Diagnostics
Quest Diagnostics empowers people to take action to improve health outcomes. Derived from the world’s largest data source of scientific lab results, our diagnostic insights reveal new avenues to recognize and treat condition, inspire healthy behaviors plus improve health care management. Mission annually serves one within three adult Americans and half the particular physicians plus hospitals in the United States, and our nearly 50, 000 employees understand that, in the right hands and with the right context, our diagnostic ideas can inspire actions that transform lives. www.QuestDiagnostics.com
[i] T-SPOT. TB . Package insert. Oxford Immunotec Inc; 2013.
[ii] Lewinsohn DM, Leonard MK, LoBue PA, et al. Official American Thoracic Society/Infectious Diseases Society of America/Centers for Disease Control plus Prevention clinical practice guidelines: diagnosis associated with tuberculosis in adults and children. Clin Infect Dis. 2017; 64(2): e1-e33. doi: 10. 1093/cid/ciw694
[iii] David M. Lewinsohn , Michael K. Leonard , Philip A. LoBue , David L. Cohn , Charles T. Daley , Ed Desmond , Joseph Keane , Deborah The. Lewinsohn , Ann Meters. Loeffler , Gerald H. Mazurek , Richard M. O’Brien , Madhukar Pai , Luca Richeldi, Max Salfinger, Thomas M. Shinnick , Timothy R. Sterling , David M. Warshauer , Gail L. Woods , Official American Thoracic Society/Infectious Diseases Society of America/Centers regarding Disease Control and Avoidance Clinical Practice Guidelines: Diagnosis of Tuberculosis in Adults and Children, Clinical Infectious Diseases , Volume 64, Issue 2, 15 January 2017 , Pages e1–e33, https://doi.org/10.1093/cid/ciw694
[iv] Filardo TD, Feng P, Pratt RH, Price SF, Self JL. Tuberculosis — United States , 2021. MMWR Morb Mortal Wkly Rep 2022; 71: 441–446. DOI: http://dx.doi.org/10.15585/mmwr.mm7112a1external icon.
[v] CDC FACT SHEET TB in the United Says : A Snapshot. Sept. 2018 . TB in the us (cdc. gov)
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