Tuberculosis (TB) is a prolonged infection of worldwide health concern owing to the load of high incidence, medical expenses, drug resistance, and coinfection. Drug-induced liver injury (DILI) is the main adverse event of anti-TB treatment, leading to nonadherence, treatment failure, or development of drug resistance. Universally, anti-TB DILI is reported in 2% to 28%.

The clinical features of anti-TB DILI may differ from mild asymptomatic elevation of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) to acute hepatitis or even liver failure.

In a retrospective study140 hospitalized patients were diagnosed with anti-TB DILI through January 2009 to December 2015. The baseline characteristics were evaluated and performed regular follow-up up to the 24th week to evaluate the probable risk factors related with the condition.

The study consists of 58.6% male and 41.4% female patients; out of which 20.7% were identified with grades 4–5 DILI and 79.3% with grades 1–3 DILI. Female patients were suggestively more likely to be identified with grades 4–5 DILI than with grades 1–3 DILI (58.6% vs. 36.9%, p=0.036). Patients treated with a multidrug anti-TB regimen were usually affected with grades 4–5 DILI (86.2% vs. 68.5%, p=0.045). A noteworthy number of patients who reinitiated anti-TB therapy suffered severe liver injury in contrast to patients with grades 1–3 DILI (41.4% vs. 10.8%, P<.001). Laboratory examinations discovered pointedly higher values for total bilirubin (TBL), International normalized ratio (INR), and Hy’s law (P<.001) in the grades 4–5 group equate to the grades 1–3 group.

The study analyzed the frequency, clinical manifestations, biochemical characteristics, and outcomes based on the different grades of anti-DILI.  The clinical exhibitions of anti-tuberculosis drug-induced liver injury are varied and non-specific and can differ from an asymptomatic liver dysfunction to severe acute hepatitis, or even acute liver failure.

The study demonstrates that anti-TB DILI is a communal adverse event described in patients with tuberculosis, which is more common in female patients. Female gender, combination therapy for antitubercular drugs (isoniazid, rifampicin and pyrazinamide), re-challenge remained the risk factors linked with the severity of anti-TB DILI; high total bilirubin, INR, MELD score and presence of hepatic encephalopathy indicated poor prognosis. Therefore it is required to recommend selective anti-TB chemotherapy in high risk patients to decrease the incidence of DILI.

Source: Med Sci Monit. 2020;26:e920350. Published 2020 Mar 7.