Epidemiology of tuberculosis and hepatitis C virus (HCV) coinfection in the country of Georgia Restricted; Files Only

Baliashvili, Davit (Fall 2021)

Permanent URL: https://etd.library.emory.edu/concern/etds/rj430593q?locale=en


Background: Tuberculosis and hepatitis C are major global public health problems. In addition to the burden that these two diseases pose separately, a substantial proportion of individuals are affected by both infections. However, there is a critical knowledge gap about how TB and HCV infection affect each other. The overarching goal of this dissertation was to characterize the epidemiology and impact of TB/HCV coinfection by analyzing nationwide data from the country of Georgia.

Methods: This dissertation included three studies to address knowledge gaps about the overlap of TB and HCV. In the first study, we compared the hepatitis C care cascade among patients with and without TB. The second study aimed to explore how hepatitis C affected the occurrence of TB and whether the incidence of TB was different among persons with treated and untreated hepatitis C. In the third study, we assessed the effect of HCV on TB recurrence and mortality in a cohort of patients successfully treated for TB.

Results: In the first study, we found that loss to follow-up from hepatitis C care was more common among patients with TB. Specifically, 20% of adult patients with TB and a positive HCV screening test did not undergo HCV confirmatory testing, and 43% of those with confirmed HCV did not start treatment for hepatitis C. The second study demonstrated that patients with hepatitis C, especially those with untreated infection, have a higher incidence of TB than those without HCV. The third study found that untreated HCV infection was associated with TB recurrence among patients with drug-susceptible TB. There was no association between HCV coinfection and mortality.

Conclusion: A more integrated approach is needed to manage patients with TB and HCV to reduce loss to follow-up from hepatitis C care, prevent active TB disease among hepatitis C patients, and improve long-term outcomes. This project was the first step in addressing the epidemiology and impact of overlap between hepatitis C and TB. It also provides multiple future opportunities to explore the other angles of this overlap.

Table of Contents

Chapter 1: Background 1

Introduction and Dissertation Aims 1

Epidemiology of tuberculosis 3

Epidemiology of hepatitis C 10

TB/HCV coinfection 15

Data sources for dissertation 21

Summary 24

Chapter 2: Hepatitis C cascade of care among patients with and without tuberculosis 26

Abstract 26

Introduction 28

Methods 30

Results 34

Discussion 37

Chapter 3: Association of treated and untreated HCV infection with active tuberculosis disease 54

Abstract 54

Introduction 56

Methods 58

Results 63

Discussion 65

Supplemental material for chapter 3 79

Chapter 4: All-cause mortality and TB recurrence among patients successfully treated for TB: the role of HCV coinfection 83

Abstract 83

Introduction 85

Methods 87

Results 93

Discussion 96

Supplemental material for chapter 4 116

Chapter 5: Summary and conclusion 124

Overview of main findings 124

Strengths and limitations 125

Implications 127

Future directions 129

References 131

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