The prevalence of drug induced hepatotoxicity among HIV positive and HIV negative patients with pulmonary tuberculosis in Benin city, Nigeria

Abstract

Introduction: Drug induced hepatotoxicity is a recognized problem associated with the anti-tuberculosis (anti-TB) chemotherapy and is of great concern especially in this era of HIV infection.
Objectives: To obtain the prevalence of hepatotoxicity due to anti-TB medications in HIV positive and negative patients with pulmonary TB.
Method: This was a prospective case control study conducted on pulmonary TB patients with HIV (cases) or without (controls) HIV co-infection attending the respiratory and Institute of Human Virology Clinics or admitted into the Medical wards of the University of Benin Teaching Hospital (UBTH), Benin City. Two hundred and ninety four patients were recruited into the study, of which 148 were HIV positive and 146 were HIV negative. Liver function tests were done prior to commencement of therapy and all subjects were followed up at 2 weeks, 4 weeks and 8 weeks respectively. Hepatotoxicity was diagnosed using serum alanine aminotransferase (ALT) and/or aspartate aminotransferase (AST) >3 times the upper limit of normal ( 12 IU/L) and/or total bilirubin of >25.5μmol/L with or without symptoms.
Results: One hundred and thirty two HIV positive and 129 HIV negative patients completed the study. Mean age of the cases was 35.32 ± 11.86 with range of 17 – 78 years, of which 47% were females and 53% males. Hepatotoxicity was observed in 15 patients (10 HIV positive and 5 HIV negative patients), giving a hepatotoxicity rate of 7.6% among HIV positive patients and 3.95% in HIV negative patients (p = 0.175). Hepatotoxicity mostly occurred within 2 weeks of commencement of therapy and was associated with older age, female gender. An inverse relationship of hepatotoxicity and CD4 was a significant risk factor for hepatotoxicity.
Conclusion: Anti-TB drug induced hepatotoxicity is not uncommon and tends to occur more in HIV positive than HIV negative patients. Early detection and prompt discontinuation of therapy will help to reduce mortality.

Keywords: Tuberculosis, Anti-TB, Drug induced hepatotoxicity, Prevalence

Tuberculosis, Anti-TB, Drug induced hepatotoxicity, Prevalence