Drug-induced liver injury from antituberculous treatment: a retrospective study from a large TB centre in the UK

Abstract

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.

Nationwide analysis of treatment outcomes in children and adolescents routinely treated for tuberculosis in the Netherlands

“…Case fatality rates (CFR) for other sub-population are presented in Supplementary Table 2 [28,29], its clinical implication in increasing the risk of mortality should be taken seriously. Two studies from India and the UK also reported DILI as a contributing cause of death in adult TB patients [30,31], with the risk of mortality being even higher if accompanied by jaundice, ascites or encephalopathy [31]. Based on the current WHO guidelines for children, regular monitoring of liver function tests (LFTs) during TB-therapy is not mandatory and only recommended if liver tenderness, hepatomegaly, jaundice or early onset of vomiting occur during treatment [32].…”

Isoniazid Induced Liver Injury; a Case Series and Review

“…[9] From the patients who developed drug induced liver injury almost 50% of patients develop due to the antitubercular therapy, Hence ATT should be considered for universal liver monitoring particularly during the first 8 weeks of treatment. [10] Further similar study may clearly suggest the importance of routine test of liver function test of the patient on ATT.…”

Clinical Profile of Patients with Disseminated Tuberculosis (DTB) in Human Immune Deficiency Virus (HIV) Infection

“…Various other studies have shown the incidence of hepatoxicity ranging from 6.9% -8.7%. 26,27 CONCLUSION TB poses a significant threat to global health still today, causing the second highest mortality rates from an infectious disease worldwide, after HIV/AIDS. In this study, an analysis of 54 patients was done who were diagnosed to have Disseminated TB and HIV co-infection.…”