Hepatotoxicity due to rifampicin, isoniazid and pyrazinamide in patients with tuberculosis: Is anti-HCV a risk factor?
Journal Title: Annals of Hepatology - Year 2010, Vol 9, Issue 1
Abstract
Background and Rationale. Among the adverse events related to tuberculosis treatment, hepatotoxicity is the most serious, and recognition of risk factors for it is essential to achieve successful therapy. The aim of the study is to evaluate the role of anti-HCV as a risk factor for hepatotoxicity in hospitalized patients under tuberculosis treatment with rifampicin, isoniazid and pyrazinamide (RHZ). Methods. Historical cohort study carried out at Hospital Sanatório Partenon, from 1998 to 2006. Patients aged 18 years or older, tested for anti-HCV, who presented normal pre-treatment aminotransferases (AST, ALT) and bilirrubin and who used RHZ during hospitalization were included in the study. Individuals who used anti-tuberculosis drugs six months prior to hospitalization, had clinical evidence of chronic liver disease or showed previous history of hepatotoxicity to RHZ were excluded. Results. A sample of 534 patients was studied. The incidence of hepatotoxicity was 8.8% (n = 47). After univariate analysis, the following variables were associated to hepatotoxicity: anti-HIV positive, anti-HCV positive, use of antiretroviral therapy and high doses of rifampicin and isoniazid per kg of body weight (p < 0.05). When Cox regression was performed, anti-HIV positive [RR = 2.3 (IC[sub]95% [/sub]1.2-4.1); p = 0.008] and high doses of isoniazid per kg of body weight [RR = 1.3 (IC[sub]95%[/sub] 1.1-1.7); p = 0.016] remained independently associated to development of hepatotoxicity. Conclusions. In conclusion, the anti-HIV positive and high doses of isoniazid were considered independent risk factors for hepatotoxicity due to RHZ esqueme in the present study. Though univariate analysis showed that anti-HCV was associated to the outcome, it was not identified as an independent risk factor for hepatotoxicity related to the use of RHZ when the analysis was controlled to HIV.
Authors and Affiliations
Lysandro Nader, Angelo de Mattos, Pedro Picon, Sérgio Bassanesi, Margarita Pineiro Rodriguez
Keywords
Related Articles
- EP ID EP77913
- DOI -
- Views 111
- Downloads 0
Liver transplantation in the critically ill: donation after cardiac death compared to donation after brain death grafts
Patients with end stage liver disease may become critically ill prior to LT requiring admission to the intensive care unit (ICU). The high acuity patients may be thought too ill to transplant; however, often LT is the o...
Hepatotoxicity associated with dietary energy supplements: use and abuse by young athletes
In recent years there has been a significant increase in the consumption of dietary energy supplements (DES) associated with the parallel advertising against obesity and favoring high physical performance. We present th...
Sirolimus based immunosuppression is associated with need for early repeat therapeutic ERCP in liver transplant patients with anastomotic biliary stricture
Introduction. Sirolimus has inhibitory effects on epithelial healing and cholangiocyte regeneration. In liver transplantation (LT) patients, these effects may be greatest at the biliary anastomosis. We therefore investig...
Redox state and methods to evaluate oxidative stress in liver damage: From bench to bedside
Oxidative stress is importantly involved in the pathophysiology of various liver diseases. The redox state participates on the courseof the inflammatory, metabolic and proliferative liver diseases. The main sources of t...
Clinical Findings of HCV Chronic Infection in Undocumented Immigrants and Low-Income Refugees in Three Areas of Southern Italy
Introduction and aim. In recent decades, Italy has become a land of immigration from countries suffering a socio-economic crisis. The aim of this study was to perform an organized screening to identify and offer care to...