Drug-induced liver injury from antituberculous treatment: a retrospective study from a large TB centre in the UK.
We describe drug-induced liver injury (DILI) secondary to antituberculous treatment (ATT) in a large tuberculosis (TB) centre in London; we identify the proportion who had risk factors for DILI and the timing and outcome of DILI.



We identified consecutive patients who developed DILI whilst on treatment for active TB; patients with active TB without DILI were selected as controls. Comprehensive demographic and clinical data, management and outcome were recorded.



There were 105 (6.9%) cases of ATT-associated DILI amongst 1529 patients diagnosed with active TB between April 2010 and May 2014. Risk factors for DILI were: low patient weight, HIV-1 co-infection, higher baseline ALP, and alcohol intake. Only 25.7% of patients had British or American Thoracic Society defined criteria for liver test (LT) monitoring. Half (53%) of the cases occurred within 2 weeks of starting ATT and 87.6% occurred within 8 weeks. Five (4.8%) of seven deaths were attributable to DILI.



Only a quarter of patients who developed DILI had British or American Thoracic Society defined criteria for pre-emptive LT monitoring, suggesting that all patients on ATT should be considered for universal liver monitoring particularly during the first 8 weeks of treatment.
Department of Infection, Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK. aula.abbara@gmail.com.|NHLI, Imperial College London, London, UK. aula.abbara@gmail.com.
Aula
A
Abbara
Department of Infection, Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK.
Sarah
S
Chitty
Department of Infection, Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK.|Department of Immunology, University College London, London, UK.
Jennifer K
JK
Roe
Department of Infection, Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK.
Rohma
R
Ghani
School of Social and Community Medicine, University of Bristol, Bristol, UK.
Simon M
SM
Collin
Department of Infection, Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK.
Andrew
A
Ritchie
Department of Chest and Allergy, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
Onn Min
OM
Kon
Department of Infection, Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK.
John
J
Dzvova
Department of Infection, Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK.
Harriet
H
Davidson
Department of Infection, Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK.
Thomas E
TE
Edwards
Department of Infection, Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK.
Charlotte
C
Hateley
Department of Infection, Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK.
Matthew
M
Routledge
Department of Infection, Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK.
Jim
J
Buckley
Department of Infection, Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK.
Robert N
RN
Davidson
Department of Infection, Northwick Park Hospital, London North West Healthcare NHS Trust, London, UK.
Laurence
L
John
D000293:Adolescent; D000328:Adult; D000995:Antitubercular Agents / Q000009:adverse effects / Q000627:therapeutic use; D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D014376:Tuberculosis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D006113:United Kingdom; D055815:Young Adult
D000995:Antitubercular Agents
Drug induced liver injury; Hepatotoxicity; Liver failure; Re-introduction regimen; Risk factors; Tuberculosis