Drug Induced Hepatitis; Does Hepatitis B and Hepatitis C Co-infection Increases the Risk during Anti Tuberculous Chemotherapy

Tuberculosis is and had remained a major health problem in both developing and developed 1 countries including Pakistan. According to world health organization Pakistan ranks 8th amongst the countries with highest burden of TB in the world and the incidence of sputum positive TB 2 cases in Pakistan is 80/100,000 per year . So in Pakistan a country of 170 million, approximately 1.5 million (1%) people are suffering from tuberculosis, while 260,000 new cases occur each 2 year . Similarly Hepatitis B and hepatitis C are the most common cause of chronic liver disease 3 worldwide, and about 200 million people are infected with HCV worldwide and amongst them 4 10 million people are in Pakistan amounting to 5% of the general population. Like wise chronic HBV 5 effects 350 million world wide and in Pakistan the overall seroprevalence of HBV in healthy adults 6 amounts to 2.4 %( 1.4-11%) of general population. Infection with Hepatitis B virus or hepatitis C virus is a common cause of chronic liver disease and it is a likely possibility that they may co-infect a person suffering from 7 tuberculosis . A recent study found high baseline HBV DNA in patient samples to be a risk factor for 8 DILI .