Prevalence of and risk factors associated with hepatitis prior to treatment of new smear positive tuberculosis patients in the lower northern Thailand
The prospective study aimed to study prevalence of and risk factors associated with hepatitis prior to treatment of new smear positive tuberculosis patients, aged over 18 years in the lower north of Thailand. Stratified sampling method was used and a total of 413 patients were enrolled for participation in the study from 46 public hospitals in 5 provinces in the lower north region including Phitsanulok, Uttaradit, Phetchabun, Sukhothai and Tak Province. Data were analyzed using descriptive statistics, chi-square and odd ratio. It was found that the prevalence of hepatitis prior to treatment of tuberculosis was 6.5%. Factors related to the incidence of hepatitis before TB treatment were: (1) Behavioral factors: Patients who drank alcohol were 6.4 times more likely to develop hepatitis before treatment of tuberculosis. In addition, individuals who currently drink are 4.9 times more likely to develop non-severe hepatitis prior to TB treatment than those who do not drink or used to drink. (2) Genetic factors: Patients who have a family history of liver disease were 4.3 times more likely to develop hepatitis before TB treatment and 5.8 times more likely to develop non-severe hepatitis prior to TB treatment than those who do not have a family history of liver disease. (3) Demographic factors: Individuals with HIV infection were 8.6 times more likely to develop hepatitis before TB treatment 7.7 times more likely to develop non-severe hepatitis prior to TB treatment, and 12.4 times more likely to develop severe hepatitis prior to TB treatment than HIV-negative populations. The results of this study indicated that factors related to hepatitis before TB treatment are alcohol consumption, HIV infection and history of liver disease in the family. In response to findings from this study, an adjustment to Thailand’s current tuberculosis treatment and care guidelines is being proposed and it is recommended that liver function tests be performed before initiating treatment of tuberculosis for TB patients with history of alcohol abuse, HIV infection or history of liver disease in the family. As for policy recommendation, the Ministry of Public Health, Department of Disease Control, Bureau of Tuberculosis, National Health Security Office are advised to establish and implement the guidelines for treatment and care and benefits for tuberculosis patients at risk for developing hepatitis prior to receiving TB treatment.
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