The association of hepatitis B virus (HBV) infection in the outcomes of drug-induced liver injury (DILI) remains controversial. A recent study evaluated the characteristics and outcomes of DILI, with an emphasis on the impact of HBV infection. Patients with DILI from multiple centers were prospectively recruited for the study.

The observations were as follows-

• 1,014 patients were enrolled for the study. 
• The foremost offender drug category was found to be antimicrobials (47.4%), followed by nonsteroidal anti-inflammatory drugs, anticonvulsants, and statins. 
• Among the antimicrobials, antituberculosis agents were found to be most credible to induce liver injury (25.3%), followed by antibacterial, antifungal, and antiviral agents. 
• The liver-related mortality rate was found to be 8.2%.
• Higher rates of hepatocellular-type liver injury, elevated liver biochemical tests, preexisting liver cirrhosis, jaundice, chronic HBV infection, and antituberculosis drug-induced liver injury (ATDILI) was found in the patients who died than the survivors. 
• 12.9% of patients with DILI were found to be HBV carriers, of whom 17.6% died of hepatic failure. 
• The rate of HBV-DNA > 2000 IU/mL was found to be higher in the patients who died than in the survivors. 
• After adjusting for possible risk factors, active HBV infection with HBV-DNA > 2000 IU/mL was found to be the most significant risk factor for liver-related mortality. 
• The other independent risk factors for mortality were found to be ATDILI and albumin-bilirubin (ALBI) scores.

Thus, in this study Antituberculosis agents were found as the leading cause of DILI, which was also associated with poorer outcomes than other drug categories. Active HBV infection, ATDILI and ALBI scores were found to be the independent risk factors for fatal DILI. Close monitoring of liver tests and timely antiviral therapy should be conducted in HBV carriers while administering high-risk drugs, such as antituberculosis agents.

SOURCE- Journal of the Chinese Medical Association, March 2022;85(3):286-294. doi: 10.1097/JCMA.0000000000000648