Drug-induced hepatotoxicity and tuberculosis in a hospital from the Argentinian northeast: cross-sectional study.

BACKGROUND

Hepatotoxicity is a serious adverse effect of tuberculosis treatment.

OBJECTIVE

The aim of this study was to estimate the prevalence, forms of presentation and clinical course of patients with hepatotoxicity secondary to antituberculosis drugs.

METHODS

We performed a descriptive and observational study using medical records from patients older than 16 years between Jaunary 1, 2011 and June 30, 2014 in the Medical Clinic of the Hospital Angela I. de Llano, Corrientes, Argentina.

RESULTS

During the study period 118 patients were diagnosed with tuberculosis; 7.6% (nine patients: six men and three women) developed hepatotoxicity. Six had hepatocellular characteristics and three had cholestatic characteristics. The mean age was 34.6 ± 14.3 years. All patients received triple-association medication plus ethambutol on a daily basis. They were hospitalized for an average of 16 days (range: 4-37). Four were asymptomatic, three had anorexia, nausea and vomiting, and two were jaundiced. The interval between the beginning of treatment and the appearance of clinical manifestations was on average 9.6 days (range 2-23). The interval between the onset and cessation of treatment was on average 15.2 days (range 3-48). No patients required liver transplantation and no deaths were recorded.

CONCLUSIONS

Hepatotoxicity of antituberculosis drugs has been associated with factors such as age over 35 years, female gender, pregnancy, malnutrition, alcoholism, human immunodeficiency virus, preexisting liver disease, daily treatment, diabetes, renal failure, and combined treatment. Since we lack a regional registry, this casuistry could be the kickoff for the creation of regional and/or national records of anti-tuberculosis drugs adverse effects and pharmacologic vigilance. Also, there is a need for programs to actively seek this complication, and the development of guidelines for unifying concepts and treatment protocols.