Hepatitis C virus infection and hepatotoxicity during antituberculosis chemotherapy.
BACKGROUND
The risk of drug-induced hepatotoxicity (DIH) during treatment for tuberculosis (TB) in patients who are seropositive for the hepatitis C virus (HCV) is not clear. We evaluated whether HCV-seropositive patients are at a higher risk of DIH than control subjects during treatment for TB with standard short-course regimens.


METHODS
Fifty-four HCV-seropositive patients with newly diagnosed active TB who were treated with isoniazid, rifampin, ethambutol, and/or pyrazinamide were included in the study population. Ninety-seven HCV-seronegative patients were selected as control subjects.


RESULTS
Forty HCV-seropositive patients (74%) and 82 control subjects (85%) received an initial treatment regimen that included pyrazinamide. Twenty-two HCV-seropositive patients (41%) and 19 control subjects (20%) exhibited elevated liver enzyme levels during TB treatment, including transient elevation of transaminase. DIH, defined as a liver transaminase level >/= 120 IU/L, occurred more frequently in HCV-seropositive patients (7 of 54 patients, 13%) than in control subjects (4 of 97 patients, 4%). Isoniazid and rifampin were reintroduced after the liver transaminase level returned to baseline in five HCV-seropositive patients exhibiting DIH, and all these retrials proved to be successful.


CONCLUSIONS
These findings suggest that treatment for TB in HCV-seropositive patients could be pursued in the usual manner, using standard short-course regimens, with the condition that monthly liver function tests are carefully performed.
Kwon
Yong Soo
YS
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Koh
Won-Jung
WJ
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.. Electronic address: wonjung.koh@samsung.com.
Suh
Gee Young
GY
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Chung
Man Pyo
MP
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Kim
Hojoong
H
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Kwon
O Jung
OJ
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
D000328:Adult; D000995:Antitubercular Agents / Q000633:toxicity*; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006526:Hepatitis C / Q000150:complications*; D006801:Humans; D007723:Korea; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*
D000995:Antitubercular Agents