Risk factors for drug-induced liver injury in people with HIV on anti-tuberculosis treatment

Drug-induced liver injury (DILI) is a well-recognized adverse drug reaction associated with anti-tuberculosis treatment (ATT), with higher prevalence in people living with HIV (PLWH) concurrently receiving antiretroviral therapy (ART). The incidence of DILI varies widely, ranging from 5% to 33% in patients taking ATT, and from 9% to 30% in those on both ATT and ART, depending on the treatment regimen. This study aimed to identify risk factors associated with the development of DILI in PLWH.

We conducted a retrospective case-control study involving 121 patients from August 2015 to December 2023. The study population was PLWH co-infected with tuberculosis (TB) receiving guidelines-based ATT.

Fifty cases with DILI and 71 controls without liver injury were identified. Moderate DILI was observed in 14 patients (27%), and severe DILI in 37 patients (73%). DILI was diagnosed after a median interval of 32.6 days (IQR: 8-47.2), with 56% diagnosed within 30 days and 86% within 60 days of ATT initiation. Baseline BMI, CD4 T cell levels, ALT, and concomitant use of ART were associated with DILI. Furthermore, DILI was associated with increased 3-month all-cause mortality (OR 6.4, 95% CI 1.66-24.7).

A low BMI, high baseline ALT, concomitant ART, and low CD4 T cell levels at the time of TB diagnosis were associated with higher odds of DILI in PLWH. Targeted interventions on these risk factors may help reduce DILI incidence in PLWH and improve clinical outcomes.