Frequency and risk factors of drug-induced liver injury during treatment of multidrug-resistant tuberculosis

Lee, S S; Lee, C M; Kim, T H; Kim, J J; Lee, J M; Kim, H J; Ha, Chen; Jung, Woon Tae; Lee, O J; Kim, D Y

doi:10.5588/ijtld.15.0668

Cited by 26 publications

(16 citation statements)

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“…Drug-induced liver injury during anti-TB treatment is the most common reason leading to discontinuation of therapy [26]. In addition, hepatitis B and C virus are major risk factors for liver injury [27, 28]. We noted drug-induced liver injury in 9 patients (6.5%), including 2 with hepatitis B and 1 with hepatitis C. In 8 patients, all drugs were stopped and a step-wise rechallenge was initiated after complete resolution of hepatotoxicity; 1 patient died due to intestinal obstruction.…”

Section: Discussionmentioning

confidence: 99%

Clinical features and outcomes of abdominal tuberculosis in southeastern Korea: 12 years of experience

et al. 2018

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BackgroundAbdominal tuberculosis (TB) is an uncommon form of infection with Mycobacterium tuberculosis in Korea. In this study, we aimed to highlight the clinical features, diagnostic methods, and outcomes of abdominal TB over 12 years in Southeastern Korea.MethodsA total of 139 patients diagnosed as having abdominal TB who received anti-TB medication from January 2005 to June 2016 were reviewed. Among them, 69 patients (49.6%) had luminal TB, 28 (20.1%) had peritoneal TB, 7 (5.0%) had nodal TB, 23 (16.5%) had visceral TB, and 12 (8.6%) had mixed TB.ResultsThe most frequent symptoms were abdominal pain (34.5%) and abdominal distension (21.0%). Diagnosis of abdominal TB was confirmed using microbiologic and/or histologic methods in 76 patients (confirmed diagnosis), while the remaining 63 patients were diagnosed based on clinical presentation and radiologic imaging (clinical diagnosis). According to diagnostic method, frequency of clinical diagnosis was highest in patients with luminal (50.7%) or peritoneal (64.3%) TB, while frequency of microscopic diagnosis was highest in patients with visceral TB (68.2%), and frequency of histologic diagnosis was highest in patients with nodal TB (85.2%). Interestingly, most patients, except those with nodal TB, showed a good response to anti-TB agents, with 84.2% showing a complete response. The mortality rate was only 1.4% in the present study.ConclusionsMost patients responded very well to anti-TB therapy, and surgery was required in only a minority of cases of suspected abdominal TB.

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Section: Discussionmentioning

confidence: 99%

Clinical features and outcomes of abdominal tuberculosis in southeastern Korea: 12 years of experience

et al. 2018

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“…The high proportion of patients co-infected with the HCV, which was associated with a higher risk of unfavourable outcomes, may be explained by risk factors for HCV infection found commonly in MDR-TB patients (such as incarceration and drug use), prolonged contact with the health system and high HCV prevalence in the region. 21 HCV infection has been associated with higher levels of drug-induced liver injury in MDR-TB patients, 22,23 often leading to treatment interruption, itself a risk factor for unfavourable outcomes. 24 Previously active TB was a contraindication to treatment for HCV infection with interferon, frequently leading to a vicious circle of MDR-TB treatment interruptions due to druginduced hepatotoxicity and subsequent MDR-TB treatment failure.…”

Section: Discussionmentioning

confidence: 99%

Is 6 months of bedaquiline enough? Results from the compassionate use of bedaquiline in Armenia and Georgia

Hewison

Bastard²,

Khachatryan³

et al. 2018

int j tuberc lung dis

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“…During antitubercular treatment DILI is more common in patients infected by hepatotropic viruses [18]. HCV infection represents a significant risk factor for DILI in MDR-TB treatment [18], but it seems not related with outcome of these patients [18, 20].…”

Section: Discussionmentioning

confidence: 99%

Hepatitis C virus infection: a challenge in the complex management of two cases of multidrug-resistant tuberculosis

et al. 2019

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BackgroundMultidrug-resistant tuberculosis (MDR-TB) requires lengthy use of second-line drugs, burdened by many side effects. Hepatitis C virus (HCV) chronic infection increases risk of drug-induced liver injury (DILI) in these patients. Data on MDR-TB patients with concurrent HCV chronic infection treated at the same time with second-line antitubercular drugs and new direct-acting antivirals (DAAs) are lacking. We evaluate if treating at the same time HCV infection and pulmonary MDR-TB is feasible and effective.Cases presentationIn this study, we described two cases of patients with pulmonary MDR-TB and concurrent HCV chronic infection cured with DAAs at a Tertiary Infectious Diseases Hospital in Italy. During antitubercular treatment, both patients experienced a DILI before treating HCV infection.After DAAs liver enzymes normalized and HCV RNA was undetectable. Then antitubercular regimen was started according to the institutional protocol, drawn up following WHO MDR-TB guidelines. It was completed without further liver side effects and patients were declared cured from both HCV infection and MDR-TB.ConclusionsWe suggest to consider treatment of chronic hepatitis C with DAAs as a useful intervention for reintroduction of second-line antitubercular agents in those patients who developed DILI, reducing the risk of treatment interruption when re-exposed to these drugs.

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Frequency and risk factors of drug-induced liver injury during treatment of multidrug-resistant tuberculosis

Abstract: DILI during MDR-TB treatment occurred more frequently in patients with CLD due to ALD, HBV and HCV infection than in those without CLD.

Cited by 26 publications

References 0 publications

Clinical features and outcomes of abdominal tuberculosis in southeastern Korea: 12 years of experience

Clinical features and outcomes of abdominal tuberculosis in southeastern Korea: 12 years of experience

Is 6 months of bedaquiline enough? Results from the compassionate use of bedaquiline in Armenia and Georgia

Hepatitis C virus infection: a challenge in the complex management of two cases of multidrug-resistant tuberculosis

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