Abstract
Background: Hepatotoxicity to antituberculosis therapy (ATT) poses a major challenge. This often results in inadequate therapy. The risk of fulminant hepatic failure and mortality is high once icteric hepatitis develops. There is no consensus on monitoring protocols and for the reintroduction of ATT.
Methods: All patients (from the Department of Internal Medicine and Gastroenterology, Jagjivanram Hospital and the Department of Gastroenterology, Bombay Hospital, Mumbai, India) with a diagnosis of tuberculosis, who were to receive ATT during the study period, were included in the present study for prospective periodic laboratory monitoring for the development of hepatotoxicity. Those patients who developed hepatotoxicity formed GroupβA (nβ=β21), whereas those who did not develop hepatotoxicity were included in GroupβC (nβ=β179). For the purpose of comparison with GroupβA, all the patients who presented directly with ATT induced hepatotoxicity during the study period were categorized as GroupβB (nβ=β24). GroupβA and B were further studied after normalization of liver functions for sequential reintroduction with therapeutic doses at a weekly interval.
Results: In GroupβA, 66.6% (14 patients) of the patients were diagnosed in the asymptomatic period. Seven patients had symptomatic hepatitis, but none had icteric illness. There were no mortalities in GroupβA. In contrast, all the patients in GroupβB had symptomatic hepatitis (75% icteric hepatitis). There was a mortality rate of 16.6% (four patients). Of the 41 patients from Groups A and B who survived, reintroduction was successful in 38/39 (97.4%). In the remaining two patients who were in GroupβB, reintroduction was not attempted because of decompensated liver disease.
Conclusions: Periodic laboratory monitoring is important in detecting hepatotoxicity at an early stage, thereby preventing mortality. Sequential reintroduction is often successful.