Jules CN Assob, Peter F Nde, Dickson S Nsagha, Anna L Njunda, Neville M Ngum and Marcelin N Ngowe
Background: Hepatotoxicity is one of the most frequent adverse events induced by anti-tuberculosis chemotherapy and remains one of the main causes of treatment interruption during TB treatment leading to hospitalization and life threatening events. Despite the high prevalence of TB/HIV co-infection in sub-Sahara Africa, paucity of data still exists on anti-TB drugs induced hepatotoxicity in HIV patients. Therefore, this study was aimed to determine the incidence and risk factors of hepatotoxicity induced by anti-tuberculosis drugs in HIV patients.
Methods: From March to September 2013, we conducted a nested case-control study by retrospectively following up TB/HIV co-infected patients on anti-TB treatment at the Buea and Limbe Regional Hospitals. Patients who developed hepatotoxicity due to increased liver enzymes (ALAT and ASAT) after anti-TB treatment initiation were labelled as “cases” while those without hepatotoxicity were “controls”. Each case was compared with 3 randomly selected controls.
Results: From the 191 TB/HIV patients recruited in the study, 26 developed hepatotoxicity. These 26 were labelled as cases and were compared to 78 randomly selected controls. WHO HIV/AIDS clinical stage 4, BMI<18.5 Kg/m2, CD4 count<50 cells/mm3, hepatitis B co-infection, and extra pulmonary TB were significantly associated with the development of anti-TB drug induced hepatotoxicity. These variables were then analysed using multivariate logistic regression and BMI<18.5 Kg/m2 [P=0.033; AOR=3.7] and hepatitis B co-infection [P=0.019; AOR=6.6] were identified as independent predictors of anti-TB induced hepatotoxicity.
Conclusion: The incidence of anti-TB drug induced hepatotoxicity was 13.61%. The findings suggest that TB/ HIV co-infected patients presenting with poor nutritional status as defined by BMI<18.5 Kg/m2 andhepatitis B should be closely monitored by clinicians especially during the intensive phase of anti-tuberculosis chemotherapy for better patient management and for the prevention of morbidity and mortality
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