Anti tubercular therapy induced liver function tests abnormalities in human immunodeficiency virus infected individuals
Journal Title: Medical Journal Armed Forces - Year 2017, Vol 73, Issue 1
Abstract
Background: Both antitubercular therapy (ATT) and antiretroviral therapy (ART) can cause drug induced liver injury (DILI) in tuberculosis (TB) and human immunodeficiency virus (HIV) coinfection. The aim of this research was to study ATT-induced liver function test (LFT) abnormalities in HIV-infected patients. Methods: HIV-infected patients diagnosed with TB were evaluated with baseline LFT and CD4 counts. ATT regimen was modified if baseline LFT was significantly abnormal. Patients on protease inhibitors were given rifabutin instead of rifampicin. In patients on nevirapinebased ART, efavirenz was substituted for nevirapine. In ART-naive patients, the timing of introduction of ART was according to CD4 cell counts. LFT were repeated fortnightly or as clinically indicated for 10 weeks. Results: We studied 100 patients with HIV ([M – 67, F – 23], mean age: 40.05 10.75 years, mean CD4 cell count: 239.157 228.49 cells/dL). Sixty-one patients were on ART prior to diagnosis of TB. Baseline LFT abnormalities (n = 40) were similar in ART and non-ART group (28/61 vs 12/39, p = 0.13). After starting ATT, derangement of LFT was observed in majority of patients (99/100). However, liver sparing ATT was required only in 15 patients. Bilirubin >2.5 mg/dL was seen only in 9 patients. Significant rise in transaminases was commoner in patients on concurrent ART and ATT ( p = 0.044) and with baseline LFT abnormalities ( p = 0.00016). There was no case of acute liver failure or mortality. Conclusion: Mild LFT abnormalities are common in HIV-infected individuals on ATT. Concomitant use of ATT and ART and baseline LFT abnormalities increase the risk of significant DILI. However, with closer follow-up, serious liver injury can be prevented.
Authors and Affiliations
Navjyot Kaur
Keywords
Related Articles
- EP ID EP623721
- DOI 10.1016/j.mjafi.2016.12.003
- Views 64
- Downloads 0
Health care for children in Indian Armed Forces
Children of Armed Forces personnel constitute 33% of the clientele dependant on our healthcare. Various child health indicators and immunization coverage of Indian Armed Forces children is better than the national figure...
Emotional and behavioral disturbances in school going HIV positive children attending HIV clinic
Background: To study the emotional and behavioral disturbances (EBD) in school going HIV positive children attending HIV center in a tertiary care hospital. Method: This cross-sectional study was conducted on 258 HIV inf...
A study of therapy targeted EGFR/ALK mutations in Indian patients with lung adenocarcinoma: A clinical and epidemiological study
Background: Established predictive biomarkers for Non-Small Cell Lung Carcinoma (NSCLC) include sensitizing Epidermal Growth Factor Receptor (EGFR) mutations and Anaplastic Lymphoma Kinase (ALK) fusion oncogene. The prim...
Sclerosing stromal cell tumor of ovary
Sclerosing Stromal-Cell Tumor (SST) is a rare, benign sex-cord stromal ovarian neoplasm. Most patients present with menstrual irregularities, abdominal or pelvic mass and associated discomfort or pain. Some cases also pr...
Giant omental lipoma in an elderly female patient
A lipoma is a benign non-invasive encapsulated mesenchymal tumour that resembles normal fat. It is ubiquitous and the commonest tumour to affect soft tissues. Although a lipoma may arise in any tissue containing fat, ome...