Open AccessAnti-Tuberculosis Drug Induced Hepatotoxicity among TB/HIV Co-Infected Patients at Jimma University Hospital, Ethiopia: Nested Case-Control Study
Author(s) -
Alima Hassen Ali,
Tefera Belachew,
Alemeshet Yami,
Wubeante Yenet Ayen
Publication year - 2013
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0064622
Subject(s) - medicine , tuberculosis , incidence (geometry) , nested case control study , logistic regression , cohort , cohort study , body mass index , gastroenterology , pathology , optics , physics
Background This study was carried out to determine the incidence and predictors of anti-tuberculosis drug induced hepatotoxicity among TB/HIV co-infected patients at Jimma University Hospital, Ethiopia. Methods/Principal Findings A nested case-control study was conducted by reviewing charts of all TB/HIV co-infected patients who commenced anti-TB treatment from January 2008 to December 2011 at Jimma University Hospital. Patients who had developed hepatotoxicity after at least 5 days of standard doses of anti-TB drug therapy were labeled as “cases” and those without hepatotoxicity were “controls”. Each case with anti-TB drug induced hepatotoxicity was compared with 3 controls selected randomly from the cohort. From a cohort of 296 TB/HIV co-infected patients 8 were excluded from the study as the causality between anti-TB drugs and hepatotoxicity was not confirmed, 33 had developed hepatotoxicity. On bivariate logistic regression analysis, body mass index (BMI) <18.5 Kg/m 2 [P = 0.01; OR (95%CI): 3.6 (1.4–9.5)], disseminated pulmonary TB [P = 0.00; OR (95%CI): 5.6 (2.2–14.6)], CD4 count ≤50 [P = 0.016; OR (95%CI): 3.6(1.27–10.23)] and WHO stage 4 [P = 0.004, OR (95%CI): 3.8 (1.68–8.77)] were significantly associated with anti-TB drug induced hepatotoxicity. Predictor variables with p-value <0.05 by bivariate analysis were analyzed using multivariable logistic regression analysis and identified disseminated pulmonary TB [P = 0.001; AOR (95%CI) = 5.6 (2.1–15.0)] and BMI <18.5 [P = 0.014; AOR (95%CI) = 3.6 (1.3–10.1)] as independent predictors of anti-TB drug induced hepatotoxicity. Conclusions The incidence of anti-TB drug induced hepatotoxicity was 11.5%. The results suggest that in the presence of disseminated pulmonary TB and/or BMI <18.5 Kg/m 2 , TB/HIV co-infected patients should be closely followed for the occurrence of hepatotoxicity during the intensive phase of TB treatment to prevent morbidity and mortality.