Abstract
OBJECTIVE: To explore the immune changes caused by anti-tuberculosis treatment, especially the fluctuations of IFN-γ, and their role in HBV reactivation and related liver injury. METHOD: This was a retrospective study. Firstly, 162 patients with hepatitis B and tuberculosis co-infection (initial HBV-TB group) and 162 patients with simple hepatitis B infection (initial HBV group) who were hospitalized at the Third People's Hospital of Huizhou from June 2016 to September 2025 were consecutively included for preliminary comparison. Secondly, from the initial cohort, a baseline comparable subgroup was selected based on age, gender, and baseline levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) for immunological analysis (a total of 14 patients in the TB-HBV group and 11 patients in the HBV group).Additionally, within the HBV-TB group, according to whether they received preventive antiviral treatment, they were divided into an untreated subgroup (n=16) and a treated subgroup (n=20) to analyze the impact of treatment on prognosis. RESULT: The comparison of baseline data between the HBV-TB group and the HBV group showed that the proportion of males was higher in the HBV-TB group, and the levels of WBC, NEU, Mon and PLT were higher than those in the HBV group. However, the levels of HBsAg, HBVDNA, ALT, AST, Lym and RBC were lower than those in the HBV group (all P<0.05). Among HBV-TB patients who did not receive anti-HBV treatment, 81.25% of the patients(13 case)had HBV reactivation, and 43.75% of them (7case)had severe liver injury. The incidence of Drug-induced liver injury(DILI) and the rate of HBV reactivation in this group were both higher than those in the anti-HBV treatment group (all P<0.05). In terms of immune indicators, the counts of lymphocytes, total T cells and CD4+ T cells in the HBV-TB group were all lower than those in the HBV group, while the levels of IFN-γ and IL-6 were higher(all P<0.05). CONCLUSION: It is recommended that HBsAg screening be conducted for all tuberculosis patients before anti-tuberculosis treatment, and preventive antiviral treatment be given to individuals with positive HBsAg to reduce the risk of HBV reactivation.