PREVALENCE AND RISK FACTORS OF HEPATOTOXIC REACTIONS IN PATIENTS RECEIVING ANTI-TUBERCULOUS DRUGS IN SUEZ CHEST HOSPITAL

Abstract

A total of seventy-seven consecutive patients were considered eligible tor the study according to our inclusion criteria. They were included in the study from 2001 through 2002. The indications for anti-tuberculous treatment were pulmonary tuberculosis in 72 patients, pleural tuberculosis in two, tuberculous adenitis, urinary tuberculosis, tuberculous meninhritis in one patient each. They started their standardized anti-tuberculous regimens according to their case definitions and treatment categories as recommended by the WHO guidelines (1997) and they were followed up for the development of drug induced hepatotoxicity (DIH). At the end of the study we reached the following results:

• The hepatotoxic reactions have been diagnosed in seven (9%) patients out of the total of 77 studied patients, according to our criteria of diagnosing antituberculous drug induced hepatitis.

• Both AST and ALT increased with the anti-tuberculous treatment but the ALT is more liable to increase due to the treatment with anti­ tuberculous drugs. This study demonstrated that the values of liver transaminase (AST and ALT) generally didn't exceed double the normal value in the patients receiving anti-tuberculous treatment. The transaminase index (TI) were 1-2 in 48 cases (68.6%) of all the studied population.

• Tl1is study also observed that a large population of the studied subjects were prone to develop hepatotoxicity as their transaminase indices were (2-5) in 22 cases (31.4%) of the studied subject. Tl1is is near the biochemical hepatotoxic level (TI :0:5).

• The prevalence of clinical hepatotoxicity is higher than the subclinical hepatotoxicity. Two patients (28.6%) of the HTR group developed subclinical hepatotoxicity (TI :0:5 with no symptoms of hepatitis), while five patients (71.4%) developed clinical hepatotoxicity (TI :0:5 with symptoms of hepatitis).

• The continuation of the anti-tuberculous drugs after the occurrence of hepatotoxic reaction could lead to irreversible liver cell damage. In three patients (42.8%) rifampicin, isoniazid, and pyrazinamide had to be stopped temporarily because of increased intensity of symptoms and the continuous• rise of the transaminases level with-the continuation of drugs.