Incidence of antituberculosis-drug-induced hepatotoxicity and associated risk factors among tuberculosis patients in Dawro Zone, South Ethiopia: A cohort study

• Published in: International journal of mycobacteriology Vol. 5; no. 1; pp. 14 - 20
• Main Authors: Abera, Wondwossen, Cheneke, Waqtola, Abebe, Gemeda
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.03.2016; Medknow Publications and Media Pvt. Ltd; Wolters Kluwer Medknow Publications
• Subjects: Adolescent; Adult; Alanine Transaminase - blood; Alcohol Drinking - adverse effects; Anti-TB-DIH; Antitubercular agents; Antitubercular Agents - adverse effects; Antitubercular Agents - therapeutic use; Aspartate Aminotransferases - blood; Bilirubin - blood; Chemical and Drug Induced Liver Injury - epidemiology; Chemical and Drug Induced Liver Injury - etiology; Chemical and Drug Induced Liver Injury - pathology; Child; Cohort Studies; Drug resistance in microorganisms; Ethiopia; Ethiopia - epidemiology; Female; Humans; Incidence; Infectious Disease; Liver; Liver - pathology; Liver diseases; Liver function test; Liver Function Tests; Male; Medical Education; Medical laboratories; Middle Aged; Prospective Studies; Risk factor; Risk Factors; Tuberculosis; Tuberculosis - drug therapy; Tuberculosis - microbiology; Young Adult; Nepal; Ethiopia; Liver function test; Anti-TB-DIH; Ethiopia; Risk factor; Incidence
• ISSN: 2212-5531; 2212-554X
• DOI: 10.1016/j.ijmyco.2015.10.002

Abstract Background Antituberculosis drugs cause hepatotoxicity in some individuals leading to acute liver failure, which results in death. Such phenomena limit the clinical use of drugs, contributing to treatment failure that possibly causes drug resistance. Furthermore, associated risk factors for the development of antituberculosis-drug-induced hepatotoxicity (anti-TB-DIH) are found to be controversial among different study findings. Methods A prospective cohort study was conducted from May 2014 to October 2014 in Dawro Zone, Tercha District Hospital Laboratory, South Ethiopia. One hundred and twenty-four new tuberculosis-positive individuals available from Tercha Hospital and five health centers during data collection were consecutively included. The sociodemographic data and anthropometric measurement were obtained. Then, 5 mL of venous blood was drawn from each individual, and the alanine transaminase, aspartate transaminase, and total bilirubin were measured photometrically at baseline, and then continuously monitored by measuring these liver enzymes every 2 weeks for 2 months. Data were analyzed with SPSS version 20 for Windows (SPSS Inc., Chicago, IL, USA). Results The incidence of anti-TB-DIH was found to be 8% (10 patients out of 124). Raised serum transaminase and bilirubin level, as well as signs and symptoms of hepatotoxicity (nausea, anorexia, vomiting, malaise, and jaundice), were observed in the cases. The onset of hepatotoxicity ranged from 13 days to 58 days (median, 26 days) after treatment was initiated. Of the various risk factors analyzed, only high alcohol intake was associated with the incidence of anti-TB-DIH (odds ratio = 9.3, 95% confidence interval 1.8–47, p < .007). Age, gender, extent of tuberculosis disease, and malnutrition were not significantly associated with anti-TB-DIH. Conclusion The incidence of anti-TB-DIH in Dawro Zone was high. The drug responsible for the hepatotoxicity was not known. However, chronic high alcohol intake was associated with the development of anti-TB-DIH.