The Effect of Hepatoprotectors on the Risk of Drug-induced Hepatitis in Pulmonary Tuberculosis Patients

Anti-tuberculosis (TB) drugs are a common cause of hepatotoxicity. Hepatoprotective agents are often empirically used to prevent anti-TB drug-induced hepatitis (DIH). This study aimed to evaluate the incidence of DIH in new TB patients receiving hepatoprotective agents and identify associated risk factors.

A retrospective cross-sectional study was conducted on 140 new pulmonary TB patients at two hospitals in Makassar, Indonesia. The diagnosis of TB and DIH severity (based on World Health Organization criteria) was determined by pulmonologists. Data on demographics, comorbidities, time to DIH onset, liver enzyme levels such aspartate aminotransferase (AST), alanine aminotransferase (ALT), and bilirubin were analyzed using Chi-square and paired t-tests.

DIH was observed in 38 (27.1%) patients. It was more prevalent in females and individuals over 50 years. The majority of DIH cases were grade two, characterized by elevated AST (71.1%) and ALT (47.7%). Comorbidities, including diabetes mellitus (28.9%), human immunodeficiency virus (10.5%), and chronic kidney disease (2.6%), were significantly associated with a higher incidence of DIH (P < 0.001). The mean onset of DIH was within 14 days in 94.7% of cases. While AST and ALT significantly increased posttreatment (P < 0.001), bilirubin levels did not correlate with these increases. The administration of hepatoprotective agents was associated with a 73% reduction in DIH incidence.

Despite the use of hepatoprotective agents, advanced age and the presence of comorbidities significantly increase the risk of DIH in TB patients undergoing anti-TB treatment. These findings highlight the importance of careful monitoring and management of high-risk TB patients, even with hepatoprotective co-administration.