Hepatitis C and not Hepatitis B virus is a risk factor for anti-tuberculosis drug induced liver injury.

Wan Soo Kim,Woon Tae Jung,Ok Jae Lee,Chang Yoon Ha,Hyun Jin Kim,Chang Min Lee,Tae Hyo Kim,Hyun Seon You,Hyun Chin Cho,Sang Soo Lee,Hong Jun Kim,Jeong Woo Hong

doi:10.1186/s12879-016-1344-2

Abstract

BackgroundThe risk of anti-tuberculosis (TB) drug-induced liver injury (DILI) in patients with chronic viral hepatitis (CVH) is not clear. The aim of this study was to investigate incidence and risk factors associated with TB DILI in CVH and non-CVH patients.MethodsRetrospectively, a total of 128 CVH patients who received anti-TB medication from January 2005 to February 2014 were reviewed. Among these, 83 patients had hepatitis B virus (HBV), 41 patients had hepatitis C virus (HCV) and 4 patients were dual hepatitis B and hepatitis C virus co-infected (HBV + HCV) with 251 non-CVH patients who received anti-TB medication selected as the controls. There were no human immunodeficiency virus co-infected patients. Risk factors for DILI were analyzed using cox regression analysis.ResultsThe incidence of DILI was significantly higher in the HCV group (13/41 [31.7 %], p < 0.001) and HBV + HCV groups (3/4 [75.0 %], p = 0.002) compared to the control group (25/251 [10.0 %]). The incidence of transient liver function impairment in the hepatitis B virus group was higher than in the control group (18/83 [21.7 %] vs. 27/251 [10.8 %] p = 0.010), but not in DILI (11/83 [13.3 %] vs. 25/251 [10.0 %], p = 0.400). In total patients, HCV, HBV + HCV co-infection, older age, and baseline liver function abnormality were independent factors of DILI.ConclusionsIt is recommended to carefully monitor for DILI in patients with HCV or HBV/HCV co-infection, older age, and baseline liver function abnormality.

Highlights

The risk of anti-tuberculosis (TB) drug-induced liver injury (DILI) in patients with chronic viral hepatitis (CVH) is not clear
In still other studies, the incidence of transient liver dysfunction during anti-TB treatment was found to be higher in hepatitis B virus (HBV) or hepatitis C virus (HCV) infected patients than in patients without viral hepatitis, Kim et al BMC Infectious Diseases (2016) 16:50 but the incidence of DILI was not different between CVH and non-CVH patients [16,17,18,19,20]
The following data were collected from electronic medical records by computer-assisted chart review; age, sex, alcohol ingestion, body mass index (BMI), previous TB history, TB infection site, date of anti-TB drugs prescription, regimen of anti-TB drugs, HBV surface antigen (HBsAg), HCV antibodies, HBV DNA, HCV RNA, serial liver function test once in 2 weeks, including aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin, symptoms of hepatitis including anorexia, nausea, vomiting, generalized weakness, abdominal discomfort, and jaundice, and comorbidities including liver cirrhosis, chronic kidney disease, diabetes mellitus, hepatocecullar carcinoma, and other malignancies

Summary

Introduction

The risk of anti-tuberculosis (TB) drug-induced liver injury (DILI) in patients with chronic viral hepatitis (CVH) is not clear. Female gender, alcohol abuse, malnutrition, and underlying chronic liver disease have been reported to be significant risk factors for DILI during antiTB treatment [8,9,10] It remains unclear whether the incidence of DILI increases during anti-TB treatment in patients with chronic viral hepatitis (CVH). In still other studies, the incidence of transient liver dysfunction during anti-TB treatment was found to be higher in HBV or HCV infected patients than in patients without viral hepatitis, Kim et al BMC Infectious Diseases (2016) 16:50 but the incidence of DILI was not different between CVH and non-CVH patients [16,17,18,19,20]

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