title: Antitubercular therapy induced liver function tests abnormalities in human immunodeficiency virus infected individuals.
abstract: BACKGROUND
  Both antitubercular therapy (ATT) and antiretroviral therapy (ART) can cause drug induced liver injury (DILI) in tuberculosis (TB) and human immunodeficiency virus (HIV) coinfection. The aim of this research was to study ATT-induced liver function test (LFT) abnormalities in HIV-infected patients.
  
  
  METHODS
  HIV-infected patients diagnosed with TB were evaluated with baseline LFT and CD4 counts. ATT regimen was modified if baseline LFT was significantly abnormal. Patients on protease inhibitors were given rifabutin instead of rifampicin. In patients on nevirapine-based ART, efavirenz was substituted for nevirapine. In ART-naive patients, the timing of introduction of ART was according to CD4 cell counts. LFT were repeated fortnightly or as clinically indicated for 10 weeks.
  
  
  RESULTS
  We studied 100 patients with HIV ([M - 67, F - 23], mean age: 40.05 ± 10.75 years, mean CD4 cell count: 239.157 ± 228.49 cells/dL). Sixty-one patients were on ART prior to diagnosis of TB. Baseline LFT abnormalities (n= 40) were similar in ART and non-ART group (28/61 vs 12/39,p= 0.13). After starting ATT, derangement of LFT was observed in majority of patients (99/100). However, liver sparing ATT was required only in 15 patients. Bilirubin >2.5 mg/dL was seen only in 9 patients. Significant rise in transaminases was commoner in patients on concurrent ART and ATT (p= 0.044) and with baseline LFT abnormalities (p= 0.00016). There was no case of acute liver failure or mortality.
  
  
  CONCLUSIONS
  Mild LFT abnormalities are common in HIV-infected individuals on ATT. Concomitant use of ATT and ART and baseline LFT abnormalities increase the risk of significant DILI. However, with closer follow-up, serious liver injury can be prevented.
authors.affiliation: Professor & Head, Department of Internal Medicine, Armed Forces Medical College, Pune 411040, India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Puri
authors.affiliation: Assistant Professor (Medicine), Command Hospital (Southern Command), Pune 411040, India.
authors.forename: Navjyot
authors.initials: N
authors.lastname: Kaur
authors.affiliation: Resident, Department of Medicine, Armed Forces Medical College, Pune 411040, India.
authors.forename: Sunny
authors.initials: S
authors.lastname: Pathania
authors.affiliation: Assistant Professor, Department of Medicine, Armed Forces Medical College, Pune 411040, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Associate Professor, Department of Medicine, Armed Forces Medical College, Pune 411040, India.
authors.forename: P K
authors.initials: PK
authors.lastname: Sharma
authors.affiliation: Professor & Head, Department of Geriatric Medicine, Armed Forces Medical College, Pune 411040, India.
authors.forename: V K
authors.initials: VK
authors.lastname: Sashindran
keywords: Antiretroviral therapy; Antitubercular therapy; Drug induced liver injury; HIV positive; Incidence