Risk Factors and Pattern of Changes in Liver Enzymes Among the Patients With Anti-Tuberculosis Drug-Induced Hepatitis

Abstract

Background: Hepatotoxicity is one of the most frequent adverse events that occurs during tuberculosis treatment and is associated with mortality of 6% - 12% if drugs are continued after the appearance of symptoms. In most of the cases, hepatitis is evident within three months after induction of anti-tuberculosis treatment. Objectives: The current study aimed to define the pattern of changes in liver transaminases and the associated risk factors among the patients with anti-tuberculosis drug-induced hepatitis who admitted to Boo-Ali Hospital in Zahedan, Southeastern Iran. Patients and Methods: The current descriptive cross-sectional study reviewed all files of the patients with anti-tuberculosis Drug-Induced Hepatitis (DIH) who referred to Boo-Ali Hospital in Zahedan, Southeastern Iran, in five years. All patients were above 14 years, and were treated with the standard regimen (a combination of isoniazid, rifampin, pyrazinamide, and ethambutol ± streptomycin). Hepatotoxicity was defined when the liver transaminases were more than five, the Upper Limit of Normal (ULN), or had clinical symptoms with an increase of liver transaminases ≥ 3 ULN. Results: Among the 946 patients with tuberculosis disease (44% men; 56% women), 52 (5.5%) cases had drug-induced hepatotoxicity. Only 25% of the patients with anti-tuberculosis drug-induced hepatitis were below 52; 50% of the cases occurred within the first two weeks after the treatment onset. Conclusions: Anti-tuberculosis drugs-induced hepatotoxicity caused treatment interruption in 5.5% of the patients with tuberculosis. The majority of the patients with DIH were above fifty, and 50% the cases occurred during the first two weeks after treatment onset. Physicians must carefully and closely monitor such patients.