HEPATOTOXICITY DUE TO ANTITUBERCULOSIS THERAPY - CLINICAL PROFILE ANDREINTRODUCTION OF THERAPY

The clinical profile of antituberculosis treatment (ATT)-induced hepat otoxicity is variable, and the reintroduction of ATT in patients who h ave developed such injury is controversial. We conducted a prospective study to determine the clinical profile in patients with ATT-induced hepatotoxicity and to test a predefined strategy of reintroduction of ATT. Seventy-two consecutive patients with clinical evidence of ATT-in duced hepatotoxicity were included. Jaundice was the presenting sympto m in 44 (61%) patients; prodromal symptoms were present in 28 (39%). S erious complications developed in 12 (16.6%) patients (fulminant hepat ic failure in seven, subacute hepatic failure in four, hepatic encepha lopathy in one). Nine patients (three males, six females) died from th ese complications. The mean duration of treatment before the onset of hepatitis was significantly longer in the group that died (53.22 +/- 3 6.22 days) than in the rest of the patients (31.07 +/- 30.30 days; p < 0.01). Malnutrition was present in 37 of the 72 patients. After resol ution of drug induced hepatitis, reintroduction of isoniazid and rifam picin was possible in 41 of 44 patients. Thus, our results showed that ATT-induced hepatitis carried significant morbidity and mortality, th at malnutrition was common in patients with ATT-related hepatitis, and that potentially hepatotoxic antituberculosis agents could be safely reintroduced after recovery from hepatitis.