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Role of acute viral hepatitis as a confounding factor in antituberculosis treatment induced hepatotoxicity
Reprint requests: Dr S.K. Sharma, Chief, Division of Pulmonary, Critical Care & Sleep Medicine, Professor & Chairman Department of Medicine, All India Institute of Medical Sciences, New Delhi 110 029, India e-mail: sksharma@aiims.ac.in, surensk@gmail.com
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Received: ,
Abstract
Background & objectives:
Drug induced hepatotoxicity (DIH) is an important and commonly encountered adverse effect with antituberculosis (anti-TB) treatment. Acute viral hepatitis (AVH) is an important confounding reason which clinically, biochemically and histologically mimics DIH.
Methods:
The contributory role of acute viral hepatitis as a confounding factor in patients with normal baseline liver functions who developed acute hepatitis while receiving short-course anti-TB treatment was prospectively studied. The sera of all patients who developed acute hepatitis were analysed for markers for hepatitis A, B, C and E viruses.
Results:
Viral hepatitis was present in 15 of the 102 (14.7%) patients who developed acute hepatitis while receiving anti-TB treatment with hepatitis E virus being the most common cause Later onset of acute hepatitis [58 (5-133) vs. 26 (3-221) days; P=0.04], large elevations in aspartate aminotransferase (AST) [371 (30-2643) vs. 212 (63-1990 IU/l); P=0.03] and alanine aminotransferase (ALT) [388 (31-2997) vs. 225 (52-1670 IU/l); P= 0.002] and a longer time for normalization of deranged liver functions [36.7 ± 13.3 vs. 24.5 ± 19.3 days; P=0.02] indicated acute viral hepatitis as the cause of liver function derangement.
Interpretation & conclusions:
Our findings showed AVH in 14.7 per cent patients who developed hepatotoxicity while an anti-TB treatment. Therefore, in endemic areas, viral hepatitis should be sought after and excluded in all patients suspected to have DIH before attributing the hepatotoxic effect to the anti-TB drugs.
