title: Outcomes of TB/HIV co-infected patients presenting with antituberculosis drug-induced liver injury.
abstract: BACKGROUND
  South Africa has a significant burden of tuberculosis (TB). Anti-TB drug-induced liver injury (TB DILI) is one of the most serious adverse events that can arise from TB treatment (TBT). There are limited data on TB DILI among HIV-infected patients and those on antiretroviral therapy (ART).
  
  
  OBJECTIVE
  To describe characteristics of HIV-infected patients presenting with TB DILI and the proportion reintroduced on standard or modified TBT after DILI.
  
  
  METHODS
  This was a retrospective study of TB/HIV co-infected patients with DILI between 1 July 2009 and 30 September 2012. The primary focus of interest was HIV-infected patients with TB DILI on ART (ART/TB DILI) v. not on ART (TB DILI).
  
  
  RESULTS
  A total of 94 patients were included, 41 with TB DILI and 53 with ART/TB DILI. Compared with patients with TB DILI, patients with ART/TB DILI were more likely to present with symptomatic DILI (71.2% v. 51.2%; p=0.03) and had a lower median alanine aminotransferase level at diagnosis (89 IU/L v. 118 IU/L; p=0.008), a lower rate of ALT decline (-23 IU/L v. -76 IU/L; p=0.047) and longer duration of TBT at DILI diagnosis (53 days v. 11 days; p&lt;0.001). In 71.8% of patients, standard TBT was reintroduced. More patients with ART/TB DILI than TB DILI required modified TBT (37.2% v.17.1%; p=0.05; crude odds ratio 2.17; 95% confidence interval 0.95 - 4.96). The rate of death/loss to follow-up was higher in the ART/TB DILI group (18.9% v. 14.5%).
  
  
  CONCLUSIONS
  A significant number of TB/HIV co-infected patients were not able to tolerate standard TBT. Furthermore, ART appears to complicate TBT, with relatively few patients reintroduced on standard TBT.
authors.affiliation: Helen Joseph Hospital, Johannesburg, South Africa. sashelin@gmail.com.
authors.forename: Sashelin
authors.initials: S
authors.lastname: Naidoo
authors.forename: Denise
authors.initials: D
authors.lastname: Evans
authors.forename: Eefje
authors.initials: E
authors.lastname: Jong
authors.forename: Karla
authors.initials: K
authors.lastname: Mellet
authors.forename: Rebecca
authors.initials: R
authors.lastname: Berhanu
mesh_terms: D000328:Adult; D000995:Antitubercular Agents / Q000009:adverse effects*; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology* / Q000209:etiology; D060085:Coinfection; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011379:Prognosis; D012189:Retrospective Studies; D013019:South Africa / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D014376:Tuberculosis / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D000995:Antitubercular Agents