Novel risk factors and early detection of anti tubercular treatment induced liver injury—Looking beyond American Thoracic Society Guidelines

• Published in: Indian journal of tuberculosis Vol. 64; no. 1; pp. 26 - 32
• Main Authors: Latief, Muzamil, Dar, Waseem Raja, Sofi, Najeebullah, Dar, Imtiyaz Ahmad, Kasana, Basharat, Hussain, Moomin, Arshad, Faheem, Shah, Bashir Ahmad, Koul, Parvaiz Ahmad
• Format: Journal Article
• Language: English
• Published: India Elsevier B.V 01.01.2017
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anti-tubercular treatment; Antitubercular Agents - adverse effects; Chemical and Drug Induced Liver Injury - diagnosis; Chemical and Drug Induced Liver Injury - epidemiology; Chemical and Drug Induced Liver Injury - prevention & control; Child; Drug induced liver injury; Early Diagnosis; Female; Humans; India - epidemiology; Liver Function Tests; Male; Middle Aged; Practice Guidelines as Topic; Risk Factors; Societies, Medical; Tuberculosis, Pulmonary - drug therapy; Young Adult; India; Liver function tests; Drug induced liver injury; Anti-tubercular treatment
• ISSN: 0019-5707
• DOI: 10.1016/j.ijtb.2016.11.002

•ATT-induced liver injury is a serious concern in the treatment of tuberculosis.•Early detection and interruption of therapy is of utmost importance as is monitoring of liver functions.•Besides traditional risk factors, female sex and extrapulmonary tuberculosis are the two main risk factors for the development of DILI.•Frequent clinical and biochemical monitoring should be done in high-risk patients during the course of ATT. ATT remains the standard treatment for tuberculosis. Drug-induced liver injury (DILI) has been a long-standing concern in the treatment of tuberculosis (TB) infection. To study the occurrence and risk factors of DILI in patients on ATT by regular clinical and biochemical monitoring. 200 patients, in whom ATT was started, were enrolled in the study. None of the patients with established risk factor for DILI as recognized by ATS guidelines was included in our study population. Regular clinical and liver function test monitoring was done at the commencement of ATT and then at 2, 4, and 8 weeks in the intensive phase subsequently at 4 and 6 months. DILI developed in 16 patients. Among those, 10 patients (62.5%) developed early DILI and 6 patients (37.5%) developed late DILI. Female gender and extrapulmonary tuberculosis were found to be associated with increased risk of ATT-induced DILI, whereas age, BMI, and serum albumin were not found to significantly increase DILI risk. DILI is a common problem among patients on ATT in our population. Early detection not only reduces the risk of developing Hepatic Failure but also prevents mortality.