Recherche en médecine familiale et en sciences médicales
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The Risk of Hepatotoxicity Associated with HAART/Anti-Tb Co-Treatment: A Case Control Study in a Central Ethiopian Referral Hospital

Minyahil Alebachew Woldu, Henok Demeke Getaneh, Jimma Likisa Lenjisa, Gobezie Temesgen Tegegn, Gurmu Tesafye Umeta and Hunduma Dinsa Ayano

Background: Hepatotoxicity is historically the 3rd most common reason for ART toxicity related discontinuation. Liver toxicity leads to medical visit, work plan exams, and frequent hospital admissions all of which increases expenses. The objective of this study was to determine the risk of hepatotoxicity and identify the major predictors that may cause hepatotoxicity in the study place.

Methods: A case-control study was done by reviewing a total of 105 TB/HIV co- infected patients' charts.

Results: Of the total 105 patients included in the study, 21 (20%) developed hepatotoxicity. Fifty four (51.43%) of the participants were females. The mean CD4 count of the patients was 205.1 + 96.18 cells/μL and ranged from the lowest count of 51cells/μl to the highest recorded count of 559cells/μl. The most frequent anti-TB regimen prescribed was 2(INH, RIF, ETM, PZA)/4(INH, RIF). Ninety five (90.5%) of the participants were on the primarily prophylactic drugs. Of this figure, 49 (46.7%) were on cotrimoxazole. Number of female patients developed hepatotoxicity were 12 (57.1%). Most of the patients who had developed hepatotoxicity were in stage 3 of HIV/AIDS progression. Social drug use was significantly associated with development of hepatotoxicity (P=.005) with a 95% CI (0.01-311). Patients on TDF/3TC/EFV (OR= 121.7, P=.010) and D4T/3TC/NVP (OR= 47.4, P=.009) ART regimen were found to be more likely to develop hepatotoxicity compared to patients on D4T/3TC/EFV regimen. Similarly patients on 2(ERHZ)/4(RH) anti-TB regimen (OR= 575.96, P=.002) with a 95% CI (0.02-3.8), was found to be more likely to develop hepatotoxicity compared to the other types anti-Tb regimens.

Conclusions: The risk of hepatotoxicity in TB/HIV coinfected patients can be due to a number of factors among which sex, the WHO clinical staging, use of Social drugs, type of ART regimen and type of anti-TB regimen are the major, according to the findings of this study.