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Isoniazid-related fatal hepatitis
P S Millard1, T C Wilcosky, S J Reade-Christopher
1Family Practice Residency Program, Eastern Maine Medical Center, Bangor, USA.
The Western Journal of Medicine
|June 1, 1996
Summary
Fatal hepatitis from isoniazid preventive therapy disproportionately affected women and minorities. While adherence to guidelines reduces risk, careful patient selection and monitoring remain crucial for preventing severe outcomes.
Area of Science:
- Hepatology
- Public Health
- Infectious Diseases
Background:
- Tuberculosis (TB) prevention often involves isoniazid preventive therapy (IPT).
- Isoniazid can cause drug-induced liver injury, including fatal hepatitis.
- Understanding risk factors is crucial for safe IPT implementation.
Purpose of the Study:
- To characterize the clinical and demographic features of fatal hepatitis linked to single-drug isoniazid preventive therapy.
- To estimate the incidence of fatal isoniazid hepatitis.
Main Methods:
- A survey of reported cases from 1970-1992 was conducted.
- Data were sourced from state health departments, published reports, and CDC surveillance.
- A medical review panel assessed causality for deaths.
Main Results:
- Of 108 reported cases, 62 were deemed probable or possible isoniazid hepatitis.
- The majority of cases (81%) were female, and a significant proportion (79%) were non-Hispanic Black or Hispanic.
- Median time to symptom onset was 16 weeks, with jaundice being a common presentation (90%).
- Only 42% of cases were monitored monthly as recommended.
- Estimated fatal hepatitis rates were ≤4.2 per 100,000 starting therapy and ≤7 per 100,000 completing therapy.
Conclusions:
- Fatal isoniazid hepatitis is a rare but serious risk associated with IPT.
- Risk factors include female sex and minority ethnicity.
- Adherence to monitoring guidelines can mitigate, but not eliminate, the risk.
- Careful patient selection, education, and vigilant monitoring are essential.