[Anti-tuberculosis drug-induced hepatitis]

Area of Science:

• Pulmonology
• Infectious Diseases
• Hepatology

Background:

• Short-course chemotherapy (SCC) for tuberculosis (TB) was adopted in Japan in 1996.
• SCC implementation for smear-positive new TB cases was only 60% in 2003, despite global recommendations to prevent drug resistance.
• Low SCC adoption may be linked to a high elderly patient population and frequent drug-induced hepatitis.

Purpose of the Study:

• To investigate the incidence and risk factors of drug-induced hepatitis during standard antituberculosis chemotherapy.
• To assess the outcomes and fatality rates associated with drug-induced hepatitis in TB patients.
• To identify strategies for managing hepatitis during TB treatment.

Main Methods:

• Retrospective analysis of 14-year data from patients undergoing standard 6- or 9-month antituberculosis chemotherapy regimens.
• Assessment of drug-induced hepatitis frequency based on baseline liver function and patient characteristics.
• Identification of independent risk factors for drug-induced hepatitis using statistical analysis.

Main Results:

• The overall frequency of drug-induced hepatitis was 7.8%.
• Hepatitis incidence was 7.2% in patients with normal baseline liver function and 11.8% in those with abnormalities.
• Positive HCV antibody and low peripheral lymphocyte count (<1,000 cells/microL) were independent risk factors for drug-induced hepatitis. Overall mortality was 0.04%, with a 0.49% fatality rate among patients with drug-induced hepatitis.

Conclusions:

• Drug-induced hepatitis is a significant concern in Japanese tuberculosis treatment, particularly in patients with pre-existing liver abnormalities or specific risk factors.
• Despite the risks, the overall mortality associated with antituberculosis treatment and drug-induced hepatitis is low.
• Effective management strategies for hepatitis during treatment are crucial for successful tuberculosis control and preventing drug resistance.