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

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. (c) 2023 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY -NC -ND license