Tuberculosis (TB) is the primary global health threat. TB drug-induced liver injury (TB-DILI) happens in 5-28% of people on TB treatment and is the utmost common reason demanding treatment interruption. Owing to the scarcity of potent antituberculous (ATT) agents, re-challenge with first-line agents remains the standard of care. 

TB-DILI is believed to be an idiosyncratic reaction leading to hepatocellular injury and/or portal tract inflammation with cholestasis. Though definitions of laboratory strictures that constitute TB-DILI differ in the literature, it is broadly acknowledged that the diagnosis needs exclusion of all other causes of liver injury and a clear temporal relationship between treatment and liver injury.

Individuals with HIV infection are at augmented risk of TB-DILI. In a study of 198 patients from Brazil, the threat of hepatotoxicity was 7.5-fold more in HIV-infected subjects, as compared to HIV-uninfected or those with unknown serostatus. One more study from South Africa confirmed similar increase risk of hepatotoxicity from ATT among HIV infected

The proportion of TB-DILI reappearance in HIV-infected individuals is similar to that observed in HIV-uninfected individuals. Both regimen and step-wise re-challenge approaches seems safe with no noteworthy difference in TB-DILI recurrence. High bilirubin secondary to DILI might be a risk factor for recurrence. 

Source: J Global Infect Dis 2015;7:151-6