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Hepatotoxicity from isoniazid and rifampin in inner-city AIDS patients
L A Ozick1, L Jacob, G M Comer
1Department of Medicine, Harlem Hospital Center, Columbia University, College of Physicians and Surgeons, New York, New York, USA.
Objective:
To determine the incidence of hepatotoxicity due to isoniazid and rifampin in inner-city patients with active tuberculosis.
Design:
A hospital-based review of 70 consecutive in-patients in a 770-bed, inner-city hospital. The patient population is primarily African-American and Hispanic.
Methods:
Fifty-eight men and 12 women were followed from 2-12 wk (median 4 wk). Patients had to be treated for at least 2 wk to be eligible for the study. Patients were excluded if they had been on any anti-tuberculous or any other hepatotoxic drug during the 2-month period before their hospitalization. Aminotransferases, alkaline phosphatase, bilirubin, and albumin were obtained at least every 2 wk.
Results:
Hepatocellular toxicity, defined as AST and/or ALT greater than 200 IU/L, occurred in eight out of 70 (11.4%) patients. The mean age of these patients was 38.9 yr (22-58 yr). Patients with AIDS were significantly more likely to develop hepatotoxicity than those with any other risk factor (p < 0.01).
Conclusions:
Baseline aminotransferases followed by monitoring may be necessary in AIDS patients.
Insights
Hepatotoxicity from tuberculosis drugs isoniazid and rifampin occurred in 11.4% of inner-city patients. Patients with AIDS were significantly more likely to develop liver injury.
Area of Science:
- Hepatology
- Infectious Diseases
- Pharmacology
Background:
- Tuberculosis (TB) treatment commonly involves isoniazid and rifampin.
- Hepatotoxicity is a known risk associated with these anti-TB drugs.
- Inner-city populations often have a higher burden of TB and co-morbidities.
Purpose of the Study:
- To determine the incidence of drug-induced hepatotoxicity from isoniazid and rifampin.
- To identify risk factors for hepatotoxicity in active tuberculosis patients.
- To assess the occurrence of liver injury in a specific inner-city patient cohort.
Main Methods:
- A hospital-based retrospective review of 70 consecutive tuberculosis in-patients.
- Patients were treated with isoniazid and rifampin for at least 2 weeks.
- Liver function tests (aminotransferases, alkaline phosphatase, bilirubin, albumin) were monitored bi-weekly.
Main Results:
- Hepatocellular toxicity (AST/ALT > 200 IU/L) was observed in 11.4% (8/70) of patients.
- The mean age of affected patients was 38.9 years.
- Patients with Acquired Immunodeficiency Syndrome (AIDS) showed a significantly higher incidence of hepatotoxicity (p < 0.01).
Conclusions:
- Hepatotoxicity due to isoniazid and rifampin is a significant concern in inner-city tuberculosis patients.
- Baseline liver function monitoring and regular follow-up are crucial, especially for patients with AIDS.
- Further research may be warranted to explore preventative strategies for high-risk groups.