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Tuberculous Drug-induced Liver Injury and Treatment Re-challenge in Human Immunodeficiency Virus Co-infection
BACKGROUND: Tuberculosis drug-induced liver injury (TB-DILI) is the most common adverse event necessitating therapy interruption. The optimal re-challenge strategy for antituberculous therapy (ATT) remains unclear, especially in human immunodeficiency virus (HIV) co-infected individuals in high-prev...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Medknow Publications & Media Pvt Ltd
2015
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4693306/ https://www.ncbi.nlm.nih.gov/pubmed/26752869 http://dx.doi.org/10.4103/0974-777X.170499 |
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author | Costiniuk, Cecilia T. Gosnell, Bernadett I. Manzini, Thandekile C. Du Plessis, Camille N. Moosa, Mahomed Yunus S. |
author_facet | Costiniuk, Cecilia T. Gosnell, Bernadett I. Manzini, Thandekile C. Du Plessis, Camille N. Moosa, Mahomed Yunus S. |
author_sort | Costiniuk, Cecilia T. |
collection | PubMed |
description | BACKGROUND: Tuberculosis drug-induced liver injury (TB-DILI) is the most common adverse event necessitating therapy interruption. The optimal re-challenge strategy for antituberculous therapy (ATT) remains unclear, especially in human immunodeficiency virus (HIV) co-infected individuals in high-prevalence settings such as South Africa. OBJECTIVE: To determine the incidence of and risk factors for the recurrence of TB-DILI with different ATT re-challenge strategies. MATERIALS AND METHODS: We conducted a retrospective chart review of patients managed for TB-DILI from 2005 to 2013 at King Edward VIII Hospital in Durban, South Africa. Relevant clinical and laboratory data at the presentation of TB-DILI, time to recovery of liver function, method of ATT re-challenge and outcome of re-challenge were documented. RESULTS: 1016 charts were reviewed, and 53 individuals with TB-DILI (48 HIV-co-infected) were identified. Following discontinuation of ATT, the median time to alanine aminotransferase normalization was 28 days (interquartile range 13-43). Forty-two subjects were re-challenged (30 regimen re-challenges and 12 step-wise re-challenges). 5 (12%) cases of recurrent TB-DILI were noted. Recurrences were not associated with the method of re-challenge. CONCLUSION: Based on the data available, it appears that full ATT can be safely restarted in the majority of subjects with a recurrence of DILI occurring in about 12% of subjects. The method of re-challenge did not appear to impact on the risk of recurrence. Ideally, a prospective randomized trial is needed to determine the best method of re-challenge. |
format | Online Article Text |
id | pubmed-4693306 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Medknow Publications & Media Pvt Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-46933062016-01-08 Tuberculous Drug-induced Liver Injury and Treatment Re-challenge in Human Immunodeficiency Virus Co-infection Costiniuk, Cecilia T. Gosnell, Bernadett I. Manzini, Thandekile C. Du Plessis, Camille N. Moosa, Mahomed Yunus S. J Glob Infect Dis Original Article BACKGROUND: Tuberculosis drug-induced liver injury (TB-DILI) is the most common adverse event necessitating therapy interruption. The optimal re-challenge strategy for antituberculous therapy (ATT) remains unclear, especially in human immunodeficiency virus (HIV) co-infected individuals in high-prevalence settings such as South Africa. OBJECTIVE: To determine the incidence of and risk factors for the recurrence of TB-DILI with different ATT re-challenge strategies. MATERIALS AND METHODS: We conducted a retrospective chart review of patients managed for TB-DILI from 2005 to 2013 at King Edward VIII Hospital in Durban, South Africa. Relevant clinical and laboratory data at the presentation of TB-DILI, time to recovery of liver function, method of ATT re-challenge and outcome of re-challenge were documented. RESULTS: 1016 charts were reviewed, and 53 individuals with TB-DILI (48 HIV-co-infected) were identified. Following discontinuation of ATT, the median time to alanine aminotransferase normalization was 28 days (interquartile range 13-43). Forty-two subjects were re-challenged (30 regimen re-challenges and 12 step-wise re-challenges). 5 (12%) cases of recurrent TB-DILI were noted. Recurrences were not associated with the method of re-challenge. CONCLUSION: Based on the data available, it appears that full ATT can be safely restarted in the majority of subjects with a recurrence of DILI occurring in about 12% of subjects. The method of re-challenge did not appear to impact on the risk of recurrence. Ideally, a prospective randomized trial is needed to determine the best method of re-challenge. Medknow Publications & Media Pvt Ltd 2015 /pmc/articles/PMC4693306/ /pubmed/26752869 http://dx.doi.org/10.4103/0974-777X.170499 Text en Copyright: © 2015 Journal of Global Infectious Diseases http://creativecommons.org/licenses/by-nc-sa/3.0 This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms. |
spellingShingle | Original Article Costiniuk, Cecilia T. Gosnell, Bernadett I. Manzini, Thandekile C. Du Plessis, Camille N. Moosa, Mahomed Yunus S. Tuberculous Drug-induced Liver Injury and Treatment Re-challenge in Human Immunodeficiency Virus Co-infection |
title | Tuberculous Drug-induced Liver Injury and Treatment Re-challenge in Human Immunodeficiency Virus Co-infection |
title_full | Tuberculous Drug-induced Liver Injury and Treatment Re-challenge in Human Immunodeficiency Virus Co-infection |
title_fullStr | Tuberculous Drug-induced Liver Injury and Treatment Re-challenge in Human Immunodeficiency Virus Co-infection |
title_full_unstemmed | Tuberculous Drug-induced Liver Injury and Treatment Re-challenge in Human Immunodeficiency Virus Co-infection |
title_short | Tuberculous Drug-induced Liver Injury and Treatment Re-challenge in Human Immunodeficiency Virus Co-infection |
title_sort | tuberculous drug-induced liver injury and treatment re-challenge in human immunodeficiency virus co-infection |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4693306/ https://www.ncbi.nlm.nih.gov/pubmed/26752869 http://dx.doi.org/10.4103/0974-777X.170499 |
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