Antitubercular therapy induced liver function tests abnormalities in human immunodeficiency virus infected individuals

Abstract

m e d i c a l j o u r n a l a r m e d f o r c e s i n d i a 7 3 ( 2 0 1 7 ) 1 2 -1Methods: HIV-infected patients diagnosed with TB were evaluated with baseline LFT and CD4 counts. ATT regimen was modified if baseline LFT was significantly abnormal. Patients on protease inhibitors were given rifabutin instead of rifampicin. In patients on nevirapinebased ART, efavirenz was substituted for nevirapine. In ART-naive patients, the timing of introduction of ART was according to CD4 cell counts. LFT were repeated fortnightly or as clinically indicated for 10 weeks. Results:We studied 100 patients with HIV ([M -67, F -23], mean age: 40.05 AE 10.75 years, mean CD4 cell count: 239.157 AE 228.49 cells/dL). Sixty-one patients were on ART prior to diagnosis of TB. Baseline LFT abnormalities (n = 40) were similar in ART and non-ART group (28/61 vs 12/39, p = 0.13). After starting ATT, derangement of LFT was observed in majority of patients (99/100). However, liver sparing ATT was required only in 15 patients. Bilirubin >2.5 mg/dL was seen only in 9 patients. Significant rise in transaminases was commoner in patients on concurrent ART and ATT ( p = 0.044) and with baseline LFT abnormalities ( p = 0.00016). There was no case of acute liver failure or mortality. Conclusion:Mild LFT abnormalities are common in HIV-infected individuals on ATT. Concomitant use of ATT and ART and baseline LFT abnormalities increase the risk of significant DILI. However, with closer follow-up, serious liver injury can be prevented.

Daily 800 mg versus 600 mg Efavirenz for HIV Patients Treating Tuberculosis with a Rifampicin-Based Regimen: An Open Label Randomized Controlled Trial

“…Cough is a common symptom/sign in TB patients, and persistence of cough due to treatment can mislead both healthcare providers and patients. Hepatotoxicity, a frequently reported AE from RIF when used with EFV [23], because of the increased bioavailability of RIF, was infrequent and was equally distributed between both arms. Although symptoms from minor AE were mild and transient (data not shown), altogether, findings from safety and similar effectiveness favour the use of 600 mg of EFV with RIF-containing regimens.…”

Ending AIDS: The 90–90–90 strategy

“…A dynamic approach in reducing drug-induced liver toxicity among those who have higher levels of hepatic enzymes by selecting less hepatotoxic drugs and for those who are coinfected by tuberculosis (TB), selecting less hepatotoxic antitubercular therapy (ATT) regimen is vital. In a study by Puri et al 15 published in this issue, of the 100 HIV-TB co-infected individuals only 15 required a choice of less hepatotoxic antitubercular drugs. These findings may be of importance to the Revised National Tuberculosis Control Program (RNTCP) as it currently does not allow choice of a different less hepatotoxic ATT regimen.…”