title: Antitubercular therapy in patients with cirrhosis: challenges and options.
abstract: Tuberculosis (TB) has been a human disease for centuries. Its frequency is increased manyfold in patients with liver cirrhosis. The gold standard of TB management is a 6-mo course of isoniazid, rifampicin, pyrazinamide and ethambutol. Although good results are seen with this treatment in general, the management of patients with underlying cirrhosis is a challenge. The underlying depressed immune response results in alterations in many diagnostic tests. The tests used for latent TB have many flaws in this group of patients. Three of four first-line antitubercular drugs are hepatotoxic and baseline liver function is often disrupted in patients with underlying cirrhosis. Frequency of hepatotoxicity is increased in patients with liver cirrhosis, frequently leading to severe liver failure. There are no established guidelines for the treatment of TB in relation to the severity of liver disease. There is no consensus on the frequency of liver function tests required or the cut-off used to define hepatotoxicity. No specific treatment exists for prevention or treatment of hepatotoxicity, making monitoring even more important. A high risk of multidrug-resistant TB is another major worry due to prolonged and interrupted treatment.
authors.affiliation: Naveen Kumar, Chandan Kumar Kedarisetty, Shiv Kumar Sarin, Departments of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi 110070, India.
authors.forename: Naveen
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Naveen Kumar, Chandan Kumar Kedarisetty, Shiv Kumar Sarin, Departments of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi 110070, India.
authors.forename: Chandan Kumar
authors.initials: CK
authors.lastname: Kedarisetty
authors.affiliation: Naveen Kumar, Chandan Kumar Kedarisetty, Shiv Kumar Sarin, Departments of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi 110070, India.
authors.forename: Sachin
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Naveen Kumar, Chandan Kumar Kedarisetty, Shiv Kumar Sarin, Departments of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi 110070, India.
authors.forename: Vikas
authors.initials: V
authors.lastname: Khillan
authors.affiliation: Naveen Kumar, Chandan Kumar Kedarisetty, Shiv Kumar Sarin, Departments of Hepatology, Institute of Liver and Biliary Sciences, Vasant Kunj, New Delhi 110070, India.
authors.forename: Shiv Kumar
authors.initials: SK
authors.lastname: Sarin
mesh_terms: D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D004977:Ethambutol / Q000627:therapeutic use; D006801:Humans; D007154:Immune System Diseases; D007538:Isoniazid / Q000627:therapeutic use; D055985:Latent Tuberculosis / Q000150:complications / Q000188:drug therapy; D008099:Liver / Q000187:drug effects / Q000293:injuries; D008103:Liver Cirrhosis / Q000150:complications* / Q000188:drug therapy*; D008107:Liver Diseases / Q000150:complications; D017093:Liver Failure / Q000150:complications / Q000188:drug therapy; D008111:Liver Function Tests; D016031:Liver Transplantation; D015995:Prevalence; D011718:Pyrazinamide / Q000627:therapeutic use; D012293:Rifampin / Q000627:therapeutic use; D016896:Treatment Outcome; D018088:Tuberculosis, Multidrug-Resistant / Q000150:complications* / Q000188:drug therapy*
chemical_list: D000995:Antitubercular Agents; D011718:Pyrazinamide; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin
keywords: Antitubercular therapy; Drug hepatotoxicity; Immune dysfunction; Multidrug-resistant tuberculosis