Drug-induced hepatotoxicity among TB/HIV co-infected patients in a referral hospital, Ethiopia

Abstract

ObjectivesAnti-tuberculosis drug-induced hepatotoxicity is a common serious adverse drug reaction. This study intended to determine the prevalence and associated factors of drug-induced hepatotoxicity among tuberculosis and human immunodeficiency virus co-infected patients in Dessie referral hospital northeast Ethiopia.ResultsIn this cross-sectional study 84 patients were enrolled retrospectively. Data from September 1/2015 to August 30/2018 were extracted from March 1/2019 to April 1/2019. Association between dependent and independent variables was determined using the odds ratio and a P value of < 0.05 was considered as statistical significance. Out of 84 patients, 17 patients developed drug-induced hepatotoxicity which makes the prevalence of drug-induced hepatotoxicity 20.2%. The result revealed that the presence of disseminated or extrapulmonary tuberculosis [(AOR: 7.728, 95% CI (1.516–39.404)] and/or body mass index less than 18.5 kg/m2 [(AOR = 5.593, 95% CI (1.180–26.519)] were a risk factor for drug-induced hepatotoxicity. Tuberculosis and human immunodeficiency virus co-infected patients with extra- pulmonary tuberculosis and/or body mass index less than 18.5 kg/m2 should be closely followed and supervised for the development of hepatotoxicity.

Determinants of Drug-Induced Hepatotoxicity Among Patients with Human Immunodeficiency Virus Taking a High Dose of Rifapentine Plus Isoniazid Drugs at the All Africa Leprosy Tuberculosis Rehabilitation and Training Center in Addis Ababa, Ethiopia

“…The finding is comparable with results reported by Wondwossen A. et al (8%) in Ethiopia, 25 Rajani S et al (8%) from Nepal, 26 and Alsina N et al (8.8%) from Brazil. 27 However, this prevalence is lower than other studies in Ethiopia (20.2%), 28 and (11%), 11 as well in Brazil (36.7%), 29 and higher than that of the western world (4.3%). 31 The variation in the prevalence of anti-TB-DIH worldwide may be attributed to the differences in patients' characteristics, indiscriminate use of drugs, and the definition criteria of hepatotoxicity as different countries use their guidelines.…”

“…27 In this study, patients whose BMI<18.5 kg/m2 were more likely to develop hepatotoxicity compared to patients who had BMI ≥18.5, a finding which is consistent with others. 17,28,30 The possible explanation of anti-TB drugsinduced hepatotoxicity in malnutrition may be due to depletion of glutathione stores, which makes patients more vulnerable to oxidative injuries, and the slower pace at which the liver metabolizes drugs. 26,31 In a previous study conducted in Ethiopian HIV positive and negative TB patients, the development of anti-TB drugs-induced hepatotoxicity had a significant association with a decrement in the immune status of the patients as measured by the CD4 count 32 Similarly, this study revealed a statistically significant association between low CD4 counts and the development of hepatotoxicity among the participants with decreased immune status.…”

“…35 It has been reported that advanced age can be a risk factor for anti-TB drug-induced hepatotoxicity, 10,14 in the present study, however, no association was found between age of the participants and the risk of developing anti-TB drugsinduced hepatotoxicity similar to previous studies. 17,28,30,32…”

“…In this study, patients whose BMI<18.5 kg/m2 were more likely to develop hepatotoxicity compared to patients who had BMI ≥18.5, a finding which is consistent with others. 17 , 28 , 30 The possible explanation of anti-TB drugs-induced hepatotoxicity in malnutrition may be due to depletion of glutathione stores, which makes patients more vulnerable to oxidative injuries, and the slower pace at which the liver metabolizes drugs. 26 , 31 …”

Prevalence of hepatotoxicity among HIV-infected patients in Ethiopia: a systematic review and meta-analysis

“…In this study, 13 original articles consisting of 3676 study participants were included [31][32][33][34][35][36][37][38][39][40][41][42][43]. The research was carried out in Ethiopia's three (3) regions and one city administration.…”