Hepatotoxicity in an African antiretroviral therapy cohort: the effect of tuberculosis and hepatitis B

Abstract

In this African ART cohort, we found a low incidence of and minimal morbidity due to hepatotoxicity. HBsAg and concomitant tuberculosis therapy significantly increased the risk of hepatotoxicity.

British HIV Association guidelines for the management of coinfection with HIV‐1 and hepatitis B or C virus 2010

“…High rates of HBV infection are also seen in IDUs and therefore HIV/HBV is relatively common in this group of patients [77] 4.1.2 Natural history 4.1.2.1 The influence of HBV on HIV infection. The natural history of HIV infection does not seem to be influenced by hepatitis B [71,72,78] although there is an increased rate of antiretroviral-related hepatotoxicity, and immune-reconstitution hepatitis [79][80][81].…”

Antitubercular therapy induced liver function tests abnormalities in human immunodeficiency virus infected individuals

“…The other documented predictors of severe liver injury like older age, low CD4 cell count, low BMI, low albumin levels and female gender, drugs like fluconazole and cotrimoxazole 7,9,10 were not associated with higher or severe LFT abnormalities in our cohort. This may be due to comparable baseline characteristics of our cohort.…”

“…24 To prevent drug induced ALF, all patients who become symptomatic with transaminases >3Â ULN or those with transaminases >5Â ULN irrespective of symptoms; standard four drug ATT should be substituted with liver sparing ATT. 9,10 Apart from this; any other potentially hepatotoxic drug should be discontinued. 18 We studied 100 ATT naive HIV patients who were recently started on ATT.…”

“…7,8 We also have very effective antitubercular therapy (ATT) for MTb infection but again three out of four first-line anti-TB drugs (isoniazid [H], rifampicin [R] and pyrazinamide [Z]) are associated with hepatotoxicity. While concomitant administration of ATT increases the risk of ART related severe DILI 9 ; HIV infection and concurrent ART are important predictors of ATT related liver dysfunction. 10,11 The other risk factors associated with ART/ATT related DILI are Hepatitis B/C co-infection, poor nutrition status, low albumin levels, low CD4 cell count, pre-existing chronic liver disease, abnormal liver function tests (LFTs) at baseline, age >35 years, female gender and significant alcohol consumption.…”

“…10,11 The other risk factors associated with ART/ATT related DILI are Hepatitis B/C co-infection, poor nutrition status, low albumin levels, low CD4 cell count, pre-existing chronic liver disease, abnormal liver function tests (LFTs) at baseline, age >35 years, female gender and significant alcohol consumption. [8][9][10][11][12] This study was carried out with an aim to study the LFT abnormalities in ATT naive HIV positive patients who were started on ATT and to study the pattern of liver dysfunction in these patients.…”