RISK FACTORS OF ANTITUBERCULOSIS DRUGS INDUCED HEPATOTOXICITY IN HIV/AIDS PATIENTS.

Luthariana Lies, THESIS, Faculty of Medicine University of Indonesia, Jakarta 2008.

Background
Tuberculosis is the second most prevalence opportunistic infection in HIV patient who come to Ciptomangunkusumo hospital. Antituberculosis drugs consist of Rifampicin, Ethambutol, Isoniazid and Pyrazinamide could induce hepatotoxicity. As known few factors could influenced drug induced hepatotoxicity such as age, gender, genetic, alcohol, Hepatitis B, Hepatitis C infection, HIV, abnormal aminotransferase/bilirubin baseline, nutritional status and concomitant hepatotoxic drugs consumption. These risk factors usually found in HIV, that’s why risk of drug induced hepatotoxicity is huge in HIV. In Indonesia HIV infection characterized by late stage of HIV infection, age of patient relatively young and CD4 count is low. These characteristics could be risk for antituberculosis induced hepatotoxicity.

Objective
To evaluate the risk factors of antituberculosis induce hepatotoxicity in HIV/AIDS patients.

Methods
This is a case control retrospective study matching age, sex, antituberculosis regimen, and alcohol consumption. Risk factors evaluated are Hepatitis C and Hepatitis B co infection, concomitant hepatotoxic drugs consumption, abnormal baseline aminotransferase and or bilirubin. Subjects are from out patient clinic and ward of Ciptomangunkusumo hospital.

Result
We collected data from February to May 2008. There were 33 cases and 33 controls who fulfilled in inclusion criteria of this study. The age range from 21 to 40 years old (mean 29 years), 91% were male. Both in case and control group, most of subjects are intravenous drug users with CD4 count less then 200/mm³. We found 82% subjects in case group and 76% subjects in control group have Hepatitis C co-infection; also 18% subjects in case group and 6% subjects in control group have Hepatitis C coinfection. Fifty four point five percent (54.5%) subjects in case group and 42.4% subjects in control group consume other hepatotoxic drugs. Elevated baseline ALT level was found in 51.5% subjects in case group and 12% subject in control group. Univariate analysis showed that the risk of hepatotoxicity was higher in patients with elevated baseline ALT level (OR=7.5; 95% CI 1,72 32,80; p < 0,05).

Conclusion
Elevated baseline ALT level will increase antituberculosis drug induce hepatotoxicity risk up to 7.5 times. There were no association between hepatitis C, hepatitis B, concomitant hepatotoxic drugs consumption and antituberculosis drug induced hepatotoxicity in HIV/AIDS patients.

Keyword: antituberculosis drug induced hepatotoxicity, HIV/AIDS, tuberculosis

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