BackgroundWe describe drug-induced liver injury (DILI) secondary to antituberculous treatment (ATT) in a large tuberculosis (TB) centre in London; we identify the proportion who had risk factors for DILI and the timing and outcome of DILI.MethodsWe identified consecutive patients who developed DILI whilst on treatment for active TB; patients with active TB without DILI were selected as controls. Comprehensive demographic and clinical data, management and outcome were recorded.ResultsThere were 105 (6.9%) cases of ATT-associated DILI amongst 1529 patients diagnosed with active TB between April 2010 and May 2014. Risk factors for DILI were: low patient weight, HIV-1 co-infection, higher baseline ALP, and alcohol intake. Only 25.7% of patients had British or American Thoracic Society defined criteria for liver test (LT) monitoring. Half (53%) of the cases occurred within 2 weeks of starting ATT and 87.6% occurred within 8 weeks. Five (4.8%) of seven deaths were attributable to DILI.ConclusionsOnly a quarter of patients who developed DILI had British or American Thoracic Society defined criteria for pre-emptive LT monitoring, suggesting that all patients on ATT should be considered for universal liver monitoring particularly during the first 8 weeks of treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2330-z) contains supplementary material, which is available to authorized users.

ConclusionThe incidence of NTM has continued to rise since the last national survey. This represents an almost ten-fold increase since 1995. The majority of these are pulmonary isolates (in particular MAI). Possible explanations include greater awareness amongst clinicians leading to increased sampling, improvements in laboratory techniques for speciation or laboratory reporting practices. However, such a large increase most likely reflects a genuine rise in NTM infection in the population. Given this change in culture confirmation, it is imperative that a comprehensive clinical database is set up to provide national monitoring of clinically significant infections, and establish the true burden of disease present in EW and NI. P189 SHOULD SCREENING FOR CHRONIC VIRAL HEPATITIS IN PATIENTS WITH TUBERCULOSIS BE INTRODUCED TO NICE GUIDELINES?JL Potter, C Hyams, M Shaukat, ZO Babiker, VM Macavei, N Jayasekera, H Kunst, GR Foster, VLC White. Barts Health NHS Trust, London, UK 10. 1136/thoraxjnl-2014-206260.318 Background Screening for viral hepatitis is not routinely recommended in patients diagnosed with tuberculosis (TB). However there are significant similarities in the global distribution of TB and hepatitis B (HBV) and C (HCV). It remains unclear whether co-infection with HBV or HCV is a risk factor for hepatotoxicity in patients receiving anti-tuberculous therapy and significant morbidity and mortality is associated with a late diagnosis. Objectives To determine the prevalence of HBV and HCV infection among new cases of active TB across treatment centres in East London and to assess the adverse drug reactions to antituberculous treatment experienced by this population. Methods We conducted a retrospective study including all patients diagnosed with active TB during 2013 at two TB clinics in London. Data on demographic characteristics, HBV surface antigen (HBsAg), HCV antibody, human immunodeficiency virus (HIV) and adverse drug reactions were retrospectively analysed. Results In total, 472 cases of active TB were notified during 2013. The mean age was 37.7 (+/-15.3) years (range: 5-92). Males accounted for 62.3% of our cohort. 84.7% of patients were born outside of the UK with the majority of patients being born in either Bangladesh (16.5%), India (27.8%) or Pakistan (15.9%). Overall, 304 patients were screened for HBV, 302 for HCV, and 447 for HIV. Of those screened, HBsAg was detected in 3.3%, HCV antibody in 2.0% and HIV in 3.4%. All patients infected with HBV or HCV were foreign born. Hepatotoxicity was defined as an ALT greater than 5 times the upper limit of normal or requiring a change in treatment. There was no significant difference in rates of hepatotoxicity in either in HepBsAg status (p = 0.371), HCV status (p = 0.597) or HIV status (p = 0.413) but numbers of HBV and HCV infection were small. Conclusions The prevalence of HBV and HCV was significantly higher in our cohort of TB patients than the background UK prevalence, which is 0.4% for HCV, 0.3% for HBV and 0.15% for HIV. Routine screening for ...