Abstract
Hepatotoxicity is frequently reported as an adverse reaction during the treatment of tuberculosis. The aim of this study was to determine the incidence of hepatotoxicity and to identify predictive factors for developing hepatotoxicity after people living with HIV/AIDS (PLWHA) start treatment for tuberculosis. This was a prospective cohort study with PLWHA who were monitored during the first 60 days of tuberculosis treatment in Pernambuco, Brazil. Hepatotoxicity was considered increased levels of aminotransferase, namely those that rose to three times higher than the level before initiating tuberculosis treatment, these levels being associated with symptoms of hepatitis. We conducted a multivariate logistic regression analysis and the magnitude of the associations was expressed by the odds ratio with a confidence interval of 95%. Hepatotoxicity was observed in 53 (30.6%) of the 173 patients who started tuberculosis treatment. The final multivariate logistic regression model demonstrated that the use of fluconazole, malnutrition and the subject being classified as a phenotypically slow acetylator increased the risk of hepatotoxicity significantly. The incidence of hepatotoxicity during treatment for tuberculosis in PLWHA was high. Those classified as phenotypically slow acetylators and as malnourished should be targeted for specific care to reduce the risk of hepatotoxicity during treatment for tuberculosis. The use of fluconazole should be avoided during tuberculosis treatment in PLWHA.
Highlights
The treatment of tuberculosis (TB) in people living with HIV/AIDS (PLWHA) has been a constant challenge for medicine
Of the 151 (46.6%) patients who were not included in the study, 90 (27.8%) were excluded because they did not present baseline ALT and/or AST measurements and, 61 (18.2%) were considered lost to follow up since they failed to return to the service in order to measure their AST and/or ALT levels within 30 and/or 60 days after initiating treatment for TB (Fig 1)
The study population was compared with the group of individuals who were not included in the study (151/324) with regard to sex, age, CD4 cell count and use of highly active antiretroviral therapy (HAART)
Summary
The treatment of tuberculosis (TB) in PLWHA has been a constant challenge for medicine. The occurrence of adverse reactions and the possibility of drug interactions may interfere negatively with the therapeutic regimen, leading, in most cases, to its being discontinued [1]. Hepatotoxicity is a serious adverse reaction frequently observed during treatment for TB [2], and the incidence rate may vary between 2–28% [3]. Some studies have indicated that the PLOS ONE | DOI:10.1371/journal.pone.0157725. Some studies have indicated that the PLOS ONE | DOI:10.1371/journal.pone.0157725 June 22, 2016
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