Abstract
BackgroundThis study was carried out to determine the incidence and predictors of anti-tuberculosis drug induced hepatotoxicity among TB/HIV co-infected patients at Jimma University Hospital, Ethiopia.Methods/Principal FindingsA nested case-control study was conducted by reviewing charts of all TB/HIV co-infected patients who commenced anti-TB treatment from January 2008 to December 2011 at Jimma University Hospital. Patients who had developed hepatotoxicity after at least 5 days of standard doses of anti-TB drug therapy were labeled as “cases” and those without hepatotoxicity were “controls”. Each case with anti-TB drug induced hepatotoxicity was compared with 3 controls selected randomly from the cohort. From a cohort of 296 TB/HIV co-infected patients 8 were excluded from the study as the causality between anti-TB drugs and hepatotoxicity was not confirmed, 33 had developed hepatotoxicity. On bivariate logistic regression analysis, body mass index (BMI) <18.5 Kg/m2 [P = 0.01; OR (95%CI): 3.6 (1.4–9.5)], disseminated pulmonary TB [P = 0.00; OR (95%CI): 5.6 (2.2–14.6)], CD4 count ≤50 [P = 0.016; OR (95%CI): 3.6(1.27–10.23)] and WHO stage 4 [P = 0.004, OR (95%CI): 3.8 (1.68–8.77)] were significantly associated with anti-TB drug induced hepatotoxicity. Predictor variables with p-value <0.05 by bivariate analysis were analyzed using multivariable logistic regression analysis and identified disseminated pulmonary TB [P = 0.001; AOR (95%CI) = 5.6 (2.1–15.0)] and BMI <18.5 [P = 0.014; AOR (95%CI) = 3.6 (1.3–10.1)] as independent predictors of anti-TB drug induced hepatotoxicity.ConclusionsThe incidence of anti-TB drug induced hepatotoxicity was 11.5%. The results suggest that in the presence of disseminated pulmonary TB and/or BMI <18.5 Kg/m2, TB/HIV co-infected patients should be closely followed for the occurrence of hepatotoxicity during the intensive phase of TB treatment to prevent morbidity and mortality.
Highlights
The human immunodeficiency virus (HIV) epidemic led to major upsurge in tuberculosis (TB) cases and TB mortality in many countries specially southern and eastern Africa
The results suggest that in the presence of disseminated pulmonary TB and/or body mass index (BMI),18.5 Kg/m2, TB/HIV co-infected patients should be closely followed for the occurrence of hepatotoxicity during the intensive phase of TB treatment to prevent morbidity and mortality
Treatment of drug susceptible TB disease should include a standard regimen that consists of first line drugs isoniazid, rifampicin, pyrazinamide, ethambutol or streptomycin given for 2 months, followed by isoniazid and rifampicin/ethambutol for 4 to 7 months [2]
Summary
The human immunodeficiency virus (HIV) epidemic led to major upsurge in tuberculosis (TB) cases and TB mortality in many countries specially southern and eastern Africa. The World Health Organization (WHO) has classified Ethiopia as 7th among the 22 high burden countries with TB/HIV co-infection in the world and that reported lower rate of treatment success. According to WHO reports, globally there were over one in ten of the 9 million people who developed TB each year, which is equivalent to 1.1 million new TB cases among people living with HIV in 2010 [1]. The treatment of active TB disease in HIV infected patients should follow the general principles for individuals without HIV. This study was carried out to determine the incidence and predictors of anti-tuberculosis drug induced hepatotoxicity among TB/HIV co-infected patients at Jimma University Hospital, Ethiopia
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