Broaden screening in patients with TB or HBV, says study

Patients with hepatitis B virus (HBV) infection are at heightened risk of latent tuberculosis (TB), while those with latent TB are also at increased risk of HBV infection, reveals a study. Notably, the risk of co-infection is highest among Asians and those born in high-incidence countries.

“These findings support recent guidelines to increase HBV and TB screening, particularly among persons with either infection,” the investigators said.

This study used data from Kaiser Permanente Southern California during 2008‒2019. The investigators used these data to describe HBV infections—defined as a positive HBV surface antigen, e-antigen, or DNA test—and latent TB—defined as a positive Mantoux tuberculin skin test or interferon-gamma release assay test. They also calculated the adjusted odds ratios (aOR) for co-infection in patients.

A total of 1,997 HBV patients were screened for latent TB, of whom 23.1 percent were co-infected, and among 35,820 patients with latent TB screened for HBV, 1.3 percent had a co-infection. [Am J Med 2024;137:258-265.E3]

The risk of co-infection among HBV patients was highest among Asians relative to Whites (29.4 percent vs 5.7 percent; aOR, 4.78, 95 percent confidence interval [CI], 2.75‒8.31) and among those born in a high-incidence country versus low-incidence countries (31.0 percent vs 6.6 percent; aOR, 4.19, 95 percent CI, 2.61‒6.73).

Among patients with latent TB, co-infection risk was also higher among Asians (aOR, 9.99, 95 percent CI, 5.79‒17.20) and in Blacks (aOR, 3.33, 95 percent CI, 1.78‒6.23) compared with Whites.

Additionally, individuals born in high-incidence countries were at greater risk of co-infection than those born in low-incidence countries (aOR, 2.23, 95 percent CI, 1.42‒3.50). However, Asians or persons born in high-incidence states had similar screening rates to other ethnicities or individuals born in low-incidence countries.

Screening optimization

“The current study identified areas whereby screening approaches could be optimized, which will improve connection to care services, prevent progression to acute disease or chronic illness, and reduce disease transmission,” the investigators said.

First, these findings support the updated recommendations by the Centers for Disease Control and Prevention to widen HBV screening to the general US population. [MMWR Recomm Rep 2023;72:1-25]

“[P]rior guidelines for risk-based targeted screening approaches were challenging for providers to implement, as evidenced by our observation of suboptimal screening for HBV among this high-risk population of latent TB patients,” the investigators said.

Second, the current findings highlight the need for better TB screening. Based on a recent recommendation by the US Preventive Services Task Force, people born in high-incidence nations are at greater risk of infection and must be targeted for screening. [JAMA 2023;329:1487-1494]

“Our findings suggest a potential opportunity to improve risk-based targeted screening for TB by considering routine screening for TB among all persons with HBV, given their overlap in risk factors and high-risk of TB observed in the current study,” the investigators said.