Abstract
Background: Hepatotoxicity is one of the most frequent adverse events induced by anti-tuberculosis chemotherapy and remains one of the main causes of treatment interruption during TB treatment leading to hospitalization and life threatening events. Despite the high prevalence of TB/HIV co-infection in sub-Sahara Africa, paucity of data still exists on anti-TB drugs induced hepatotoxicity in HIV patients. Therefore, this study was aimed to determine the incidence and risk factors of hepatotoxicity induced by anti-tuberculosis drugs in HIV patients. Methods: From March to September 2013, we conducted a nested case-control study by retrospectively following up TB/HIV co-infected patients on anti-TB treatment at the Buea and Limbe Regional Hospitals. Patients who developed hepatotoxicity due to increased liver enzymes (ALAT and ASAT) after anti-TB treatment initiation were labelled as “cases” while those without hepatotoxicity were “controls”. Each case was compared with 3 randomly selected controls. Results: From the 191 TB/HIV patients recruited in the study, 26 developed hepatotoxicity. These 26 were labelled as cases and were compared to 78 randomly selected controls. WHO HIV/AIDS clinical stage 4, BMI<18.5 Kg/m2, CD4 count<50 cells/mm3, hepatitis B co-infection, and extra pulmonary TB were significantly associated with the development of anti-TB drug induced hepatotoxicity. These variables were then analysed using multivariate logistic regression and BMI<18.5 Kg/m2 [P=0.033; AOR=3.7] and hepatitis B co-infection [P=0.019; AOR=6.6] were identified as independent predictors of anti-TB induced hepatotoxicity. Conclusion: The incidence of anti-TB drug induced hepatotoxicity was 13.61%. The findings suggest that TB/ HIV co-infected patients presenting with poor nutritional status as defined by BMI<18.5 Kg/m2 andhepatitis B should be closely monitored by clinicians especially during the intensive phase of anti-tuberculosis chemotherapy for better patient management and for the prevention of morbidity and mortality
Highlights
In many developing countries, the disease burden of tuberculosis (TB) has been increasing as many people contract TB secondary to compromised immunity, largely due to high rates of human immunodeficiency virus (HIV) infection and the corresponding development of AIDS [1]
We investigate the incidence of and determine significant risk factors and predictors for anti-TB drug-induced hepatotoxicity (ATDIH) in patients co-infected with TB/HIV
A total of 212 HIV/TB co-infected patients visiting the Limbe and Buea Regional hospitals in Fako Division of the South West region of Cameroon were eligible for the study
Summary
The disease burden of tuberculosis (TB) has been increasing as many people contract TB secondary to compromised immunity, largely due to high rates of human immunodeficiency virus (HIV) infection and the corresponding development of AIDS [1]. In Cameroon, the incidence of TB including TB/HIV co-infection stands at 238 per 100,000 [3] and in Africa, TB is the leading cause of illness and death in people living with HIV [4]. The interaction between these two infections is bidirectional. Despite the high prevalence of TB/HIV co-infection in sub-Sahara Africa, paucity of data still exists on anti-TB drugs induced hepatotoxicity in HIV patients. This study was aimed to determine the incidence and risk factors of hepatotoxicity induced by anti-tuberculosis drugs in HIV patients
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