title: Hepatotoxicity of anti-tuberculosis chemotherapy in patients with liver cirrhosis.
abstract: OBJECTIVE
  To determine whether liver cirrhosis patients are at higher risk for drug-induced hepatotoxicity (DIH) than control subjects during treatment for tuberculosis (TB) with standard short-course regimens containing isoniazid (INH), rifampicin (RMP), ethambutol (EMB) and/or pyrazinamide (PZA).
  
  
  METHODS
  Fifty liver cirrhosis patients with newly diagnosed active TB treated with INH, RMP, EMB and/or PZA were included in the study, along with 147 patients without liver disease selected as control subjects. DIH was defined as alanine aminotransferase (ALT) > 120 IU/l with hepatitis symptoms or ALT > 200 IU/l.
  
  
  RESULTS
  The aetiology of the liver cirrhosis patients consisted of alcoholic liver cirrhosis (n = 37, 74%), hepatitis B (n = 10, 20%) and hepatitis C (n = 3, 6%). The mean Child-Pugh score of all liver cirrhosis patients was 7.0 ± 1.2. DIH was more frequently found in liver cirrhosis patients, but the difference was not statistically significant (8.0% vs. 2.7%, P = 0.115). INH and RMP were successfully rechallenged and maintained until the end of treatment in three of four liver cirrhosis patients with DIH.
  
  
  CONCLUSIONS
  Although DIH developed more frequently in TB patients with liver cirrhosis, the apparent difference in the incidence of DIH did not achieve statistical significance. Most of the patients with DIH were successfully treated with a standard short-course regimen including INH and RMP.
authors.affiliation: Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: H J
authors.initials: HJ
authors.lastname: Shin
authors.affiliation: Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: H S
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Y I
authors.initials: YI
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: S C
authors.initials: SC
authors.lastname: Lim
authors.affiliation: Department of Internal Medicine, Gwangju Christian Hospital, Gwangju, Republic of Korea.
authors.forename: J P
authors.initials: JP
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine, Gwangju Christian Hospital, Gwangju, Republic of Korea.
authors.forename: Y C
authors.initials: YC
authors.lastname: Ko
authors.affiliation: Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Y S
authors.initials: YS
authors.lastname: Kwon
mesh_terms: D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000995:Antitubercular Agents / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood / Q000175:diagnosis / Q000209:etiology*; D004796:Clinical Enzyme Tests; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*
chemical_list: D000995:Antitubercular Agents; D015415:Biomarkers; D000410:Alanine Transaminase