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

Area of Science:

• Hepatology
• Infectious Diseases
• Pharmacology

Background:

• Coinfection with tuberculosis (TB) and human immunodeficiency virus (HIV) presents a challenge due to potential drug-induced liver injury (DILI) from both antitubercular therapy (ATT) and antiretroviral therapy (ART).
• Understanding the incidence and risk factors for liver function test (LFT) abnormalities is crucial for managing HIV-infected patients undergoing TB treatment.

Purpose of the Study:

• To investigate the occurrence and characteristics of ATT-induced LFT abnormalities in HIV-infected patients.
• To identify factors associated with increased risk of DILI in this patient population.

Main Methods:

• Prospective evaluation of 100 HIV patients with TB, including baseline LFT and CD4 counts.
• Modification of ATT regimens based on baseline LFTs; substitution of rifampicin with rifabutin or nevirapine with efavirenz in specific ART regimens.
• Close monitoring of LFTs for 10 weeks, with adjustments to ART initiation timing for ART-naive patients.

Main Results:

• 99% of patients showed some LFT derangement after starting ATT, but only 15 required liver-sparing ATT.
• Significant transaminase elevation was more common in patients on concurrent ART and ATT (p=0.044) and those with baseline LFT abnormalities (p=0.00016).
• No cases of acute liver failure or mortality were reported, indicating manageable liver injury with monitoring.

Conclusions:

• Mild LFT abnormalities are frequent in HIV patients receiving ATT.
• Concomitant ART use and pre-existing LFT abnormalities are significant risk factors for DILI.
• Intensive monitoring allows for the prevention of severe liver injury in this high-risk group.