PATTERNS AND CLINICAL CHARACTERSTICS OF PATIENTS ADMITTED WITH ANTI-TB DRUG INDUCED LIVER INJURY AT THREE HOSPITALS IN ADDIS ABABA, ETHIOPIA FROM JANUARY 2014-APRIL 2019

Abstract

ABSTRACT Background: New cases of TB-infected individuals are treated by a combination of four drugs: isoniazid (INH), rifampin (RIF), pyrazinamide (PZA), and ethambutol (E). However, a variety of adverse reactions of these drugs have been reported; one of the well-known toxic effects is hepatotoxicity. Little is known about the development of hepatotoxicity in TB. Because LFT is not routinely repeated following initiation of anti-TBs, patients with asymptomatic hepatotoxicity might have been missed and detected late after overt hepatotoxicity. There are only limited number of studies on anti TB drug hepatotoxicity in Ethiopia and this study will address the patterns of clinical characteristics of patients with anti TB drug induced liver injury. Objective: To assess the patterns and clinical characteristics of patients admitted with anti TB drug induced liver injury in the medical wards at SPHMMC, St. Peter and Zewditu hospitals from January 2014-April 2019. Method- A hospital based retrospective chart review study was conducted by reviewing charts of patients admitted with anti TB drug induced liver injury or who developed it after admission at medical wards of SPHMMC, St. Peter and Zewditu hospitals from January 2014 to April 2019. Charts of all patients with anti TB drug induced liver injury in the study period were reviewed. Data was collected using structured check list and entered into a computer using Statistical Package for Social Science (SPSS) software version 25. Descriptive statistics were used to summarize sociodemographic and clinical characteristics of the patients. Result-Among 158 consecutive patients analyzed with anti TB DILI, the mean age was 39.7 yrs. There were 81 (51.3%) HIV positive and 77(48.7%) HIV negative patients with anti TB DILI. There were 16(10.1%) patients with HBV infection and 2 HCV infection. All patients took RHZE regimen and the minimum time to develop DILI was 1 week and the maximum was 12 weeks. The mean time was 2.82 weeks. Among the symptomatic patients, nausea and vomiting was the most common complaint (49.4%). There were 83 (52.5%) patients who developed jaundice and the time to develop it ranged from 1 week to 8 weeks, the mean time being 2.36 weeks. Anti TB drug was discontinued for 86(54.4%) patients and 75 of them showed clinical and biochemical improvement. Anti TB was restarted for 77(48.7%) of patients and the mean time it took was 10.47 days. Conclusion-Anti TB drug induced hepatotoxicity continues to be a major problem among hospitalized patients taking the drug. Proper clinical and laboratorial monitoring of such patients starting from the early phases of treatment eases the detection of the problem before severe injury. Key words: anti TB drugs; admitted patients with anti TB DILI; clinical characteristics.