Treatment outcomes among patients admitted to hospital with antiretroviral and/or antituberculosis drug-induced liver injury

• Published in: South African medical journal Vol. 111; no. 5; pp. 474 - 481
• Main Authors: Mehta, R, Ive, P, Evans, D, Menezes, C.N
• Format: Journal Article
• Language: English
• Published: South Africa Health and Medical Publishing Group (HMPG) 01.05.2021; Health & Medical Publishing Group
• Subjects: Adult; Anti-HIV Agents - administration & dosage; Anti-HIV Agents - adverse effects; Antitubercular agents; Antitubercular Agents - administration & dosage; Antitubercular Agents - adverse effects; Antiviral agents; Causes of; Chemical and Drug Induced Liver Injury - epidemiology; Chemical and Drug Induced Liver Injury - etiology; Chemical and Drug Induced Liver Injury - mortality; Complications and side effects; Demographic aspects; Female; HIV Infections - drug therapy; Hospital Mortality; Hospitalization; Humans; Liver diseases; Male; Patient outcomes; Retrospective Studies; Severity of Illness Index; South Africa; Tertiary Care Centers; Tuberculosis - drug therapy; South Africa
• ISSN: 0256-9574; 2078-5135
• DOI: 10.7196/SAMJ.2021.v111i5.15353

Background. South Africa (SA) has among the highest rates of HIV and tuberculosis (TB) in the world. Antituberculosis and antiretroviral treatment (ART) can cause drug-induced liver injury (DILI), consequences of which are disease relapse, treatment failure and drug resistance.Objectives. To: (i) determine the demographics of patients with DILI and the proportion of patients on antituberculosis drugs v. antiretroviral therapy or both; (ii) determine the median time to DILI after starting medication, and patterns of clinical presentation; (iii)  determine the numbers of patients successfully re-challenged to initial therapy as inpatients; and (iv) determine the in-hospital mortality rate and predictors of all-cause mortality.Methods. This was a retrospective record review of adult patients with DILI admitted to a tertiary hospital in Johannesburg, SA, between October 2015 and February 2017. Data on drug history, biochemical investigations and relevant imaging were collected.Results. The total sample was 129 records: 79 (61.2%) were males, 46 (35.7%) had TB DILI, 29 (22.5%) had ART DILI, and 54 (41.9%) had mixed TB/ART DILI. Only 7.4% (2/27) of those with ART DILI and 30.6% (11/36) with TB DILI were re-challenged to their original regimen by discharge. Patients were followed from admission until the earlier of death (10 with TB DILI, 2 with ART DILI and 9 with mixed DILI) or discharge (after a median (interquartile range) of 14.0 (9 - 23) days). In adjusted analysis, severe DILI at admission predicted allcause mortality (adjusted hazard ratio 8.58; 95% confidence interval 1.13 - 65.4).Conclusions. This study is one of only a few analyses of hospitalised patients with DILI in SA. Among those with severe DILI, outcomes are poor, the majority cannot tolerate standard regimens, and mortality is high.