Screening Practices and Risk Factors for Co-Infection with Latent Tuberculosis and Hepatitis B Virus in an Integrated Healthcare System - California, 2008-2019

Debbie E Malden; Robert J Wong; Amit S Chitnis; Theresa M Im; Sara Y Tartof

doi:10.1016/j.amjmed.2023.10.031

Screening Practices and Risk Factors for Co-Infection with Latent Tuberculosis and Hepatitis B Virus in an Integrated Healthcare System - California, 2008-2019

Am J Med. 2024 Mar;137(3):258-265.e3. doi: 10.1016/j.amjmed.2023.10.031. Epub 2023 Nov 23.

Authors

Debbie E Malden¹, Robert J Wong², Amit S Chitnis³, Theresa M Im⁴, Sara Y Tartof⁵

Affiliations

¹ Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, Calif. Electronic address: Debbie.e.malden@kp.org.
² Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Palo Alto, Calif; Gastroenterology Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif.
³ Tuberculosis Section, Division of Communicable Disease Control and Prevention, Alameda County Public Health Department, San Leandro, Calif.
⁴ Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, Calif.
⁵ Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, Calif; Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, Calif.

PMID: 38000687
DOI: 10.1016/j.amjmed.2023.10.031

Abstract

Background: Hepatitis B virus (HBV) and latent tuberculosis infection are associated with a significant global burden, but both are underdiagnosed and undertreated. We described the screening patterns and risk factors for co-infection with latent tuberculosis and HBV within a large healthcare system.

Methods: Using data from Kaiser Permanente Southern California during 2008-2019, we described HBV infections, defined as a positive HBV surface antigen, e-antigen, or DNA test, and latent tuberculosis, defined as a positive Mantoux tuberculin skin test or interferon-gamma release assay test. We estimated adjusted odds ratios (aOR) for co-infection among screened adults with either infection.

Results: Among 1997 HBV patients screened for latent tuberculosis, 23.1% were co-infected, and among 35,820 patients with latent tuberculosis screened for HBV, 1.3% were co-infected. Among HBV patients, co-infection risk was highest among Asians compared with White race/ethnicity (29.4% vs 5.7%, aOR 4.78; 95% confidence interval [CI], 2.75-8.31), and persons born in a high-incidence country compared with low-incidence countries (31.0% vs 6.6%; aOR 4.19; 95% CI, 2.61-6.73). For patients with latent tuberculosis, risk of co-infection was higher among Asian (aOR 9.99; 95% CI, 5.79-17.20), or Black race/ethnicity (aOR 3.33; 95% CI, 1.78-6.23) compared with White race/ethnicity. Persons born in high-incidence countries had elevated risk of co-infection compared with persons born in low-incidence countries (aOR 2.23; 95% CI, 1.42-3.50). However, Asians or persons born in high-incidence countries were screened at similar rates to other ethnicities or persons born in low-incidence countries.

Conclusions: Latent tuberculosis risk is elevated among HBV patients, and vice versa. Risk of co-infection was highest among persons born in high-incidence countries and Asians. These findings support recent guidelines to increase HBV and tuberculosis screening, particularly among persons with either infection.

Keywords: HBV-LTBI Co-infection; Hepatitis B Virus; Latent Tuberculosis Infection; Screening.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
California / epidemiology
Coinfection* / epidemiology
Delivery of Health Care, Integrated*
Hepatitis B virus
Hepatitis B* / complications
Hepatitis B* / diagnosis
Hepatitis B* / epidemiology
Humans
Latent Tuberculosis* / diagnosis
Latent Tuberculosis* / epidemiology
Prevalence
Risk Factors