Hepatotoxicity due to rifampicin, isoniazid and pyrazinamide in patients with tuberculosis: Is anti-HCV a risk factor?
Journal Title: Annals of Hepatology - Year 2010, Vol 9, Issue 1
Abstract
Background and Rationale. Among the adverse events related to tuberculosis treatment, hepatotoxicity is the most serious, and recognition of risk factors for it is essential to achieve successful therapy. The aim of the study is to evaluate the role of anti-HCV as a risk factor for hepatotoxicity in hospitalized patients under tuberculosis treatment with rifampicin, isoniazid and pyrazinamide (RHZ). Methods. Historical cohort study carried out at Hospital Sanatório Partenon, from 1998 to 2006. Patients aged 18 years or older, tested for anti-HCV, who presented normal pre-treatment aminotransferases (AST, ALT) and bilirrubin and who used RHZ during hospitalization were included in the study. Individuals who used anti-tuberculosis drugs six months prior to hospitalization, had clinical evidence of chronic liver disease or showed previous history of hepatotoxicity to RHZ were excluded. Results. A sample of 534 patients was studied. The incidence of hepatotoxicity was 8.8% (n = 47). After univariate analysis, the following variables were associated to hepatotoxicity: anti-HIV positive, anti-HCV positive, use of antiretroviral therapy and high doses of rifampicin and isoniazid per kg of body weight (p < 0.05). When Cox regression was performed, anti-HIV positive [RR = 2.3 (IC[sub]95% [/sub]1.2-4.1); p = 0.008] and high doses of isoniazid per kg of body weight [RR = 1.3 (IC[sub]95%[/sub] 1.1-1.7); p = 0.016] remained independently associated to development of hepatotoxicity. Conclusions. In conclusion, the anti-HIV positive and high doses of isoniazid were considered independent risk factors for hepatotoxicity due to RHZ esqueme in the present study. Though univariate analysis showed that anti-HCV was associated to the outcome, it was not identified as an independent risk factor for hepatotoxicity related to the use of RHZ when the analysis was controlled to HIV.
Authors and Affiliations
Lysandro Nader, Angelo de Mattos, Pedro Picon, Sérgio Bassanesi, Margarita Pineiro Rodriguez
Keywords
Related Articles
- EP ID EP77913
- DOI -
- Views 108
- Downloads 0
Cryptogenic Cirrhosis and Sitosterolemia: A Treatable Disease If Identified but Fatal If Missed
Sitosterolemia is an autosomal recessive metabolic disease caused by mutations in ABCG5 or ABCG8 genes which encode for the (ATP)-binding cassette (ABC) transporters that are responsible for the trafficking of xenosterol...
An update on management of Budd-Chiari syndrome
The topic of this paper is to report an update on management of Budd-Chiari syndrome (BCS). Actually, the flow-chart of BCS management comes from experts opinion and is not evidence-based due to the rarity of BCS. Manage...
New insights into the pathophysiology of nonalcoholic fatty liver disease
The consequences of pathologic adipose tissue accumulation have been described for almost all organs. Nonalcoholic fatty liver disease (NAFLD) is considered the most relevant hepatic manifestation of obesity. There is gr...
Treatment of hyperferritinemia
Elevated serum ferritin, or hyperferritinemia, is a common finding on routine bloodwork and often prompts referral for further evaluation. In the following review, we outline the various causes of hyperferritinemia and p...
IN MEMORIAM-Professor Andrew Burroughs