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Drug-induced hepatotoxicity among TB/HIV co-infected patients in a referral hospital, Ethiopia.

ABSTRACT: OBJECTIVES:Anti-tuberculosis drug-induced hepatotoxicity is a common serious adverse drug reaction. This study intended to determine the prevalence and associated factors of drug-induced hepatotoxicity among tuberculosis and human immunodeficiency virus co-infected patients in Dessie referral hospital northeast Ethiopia. RESULTS:In this cross-sectional study 84 patients were enrolled retrospectively. Data from September 1/2015 to August 30/2018 were extracted from March 1/2019 to April 1/2019. Association between dependent and independent variables was determined using the odds ratio and a P value of < 0.05 was considered as statistical significance. Out of 84 patients, 17 patients developed drug-induced hepatotoxicity which makes the prevalence of drug-induced hepatotoxicity 20.2%. The result revealed that the presence of disseminated or extrapulmonary tuberculosis [(AOR: 7.728, 95% CI (1.516-39.404)] and/or body mass index less than 18.5 kg/m2 [(AOR = 5.593, 95% CI (1.180-26.519)] were a risk factor for drug-induced hepatotoxicity. Tuberculosis and human immunodeficiency virus co-infected patients with extra- pulmonary tuberculosis and/or body mass index less than 18.5 kg/m2 should be closely followed and supervised for the development of hepatotoxicity.

SUBMITTER: Zeleke A

PROVIDER: S-EPMC6941240 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Drug-induced hepatotoxicity among TB/HIV co-infected patients in a referral hospital, Ethiopia.

Zeleke Abebe A Misiker Bethelihem B Yesuf Teshager Aklilu TA

BMC research notes 20200102 1

<h4>Objectives</h4>Anti-tuberculosis drug-induced hepatotoxicity is a common serious adverse drug reaction. This study intended to determine the prevalence and associated factors of drug-induced hepatotoxicity among tuberculosis and human immunodeficiency virus co-infected patients in Dessie referral hospital northeast Ethiopia.<h4>Results</h4>In this cross-sectional study 84 patients were enrolled retrospectively. Data from September 1/2015 to August 30/2018 were extracted from March 1/2019 to ...[more]

PMID: 31898556

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Project description:BACKGROUND: Implication of pharmacogenetic variations and efavirenz pharmacokinetics in concomitant efavirenz based antiviral therapy and anti-tubercular drug induced liver injury (DILI) has not been yet studied. We performed a prospective case-control association study to identify the incidence, pharmacogenetic, pharmacokinetic and biochemical predictors for anti-tubercular and antiretroviral drugs induced liver injury (DILI) in HIV and tuberculosis (TB) co-infected patients. METHODS AND FINDINGS: Newly diagnosed treatment naïve TB-HIV co-infected patients (n?=?353) were enrolled to receive efavirenz based ART and rifampicin based anti-TB therapy, and assessed clinically and biochemically for DILI up to 56 weeks. Quantification of plasma efavirenz and 8-hydroxyefaviernz levels and genotyping for NAT2, CYP2B6, CYP3A5, ABCB1, UGT2B7 and SLCO1B1 genes were done. The incidence of DILI and identification of predictors was evaluated using survival analysis and the Cox Proportional Hazards Model. The incidence of DILI was 30.0%, or 14.5 per 1000 person-week, and that of severe was 18.4%, or 7.49 per 1000 person-week. A statistically significant association of DILI with being of the female sex (p?=?0.001), higher plasma efavirenz level (p?=?0.009), efavirenz/8-hydroxyefavirenz ratio (p?=?0.036), baseline AST (p?=?0.022), ALT (p?=?0.014), lower hemoglobin (p?=?0.008), and serum albumin (p?=?0.007), NAT2 slow-acetylator genotype (p?=?0.039) and ABCB1 3435TT genotype (p?=?0.001). CONCLUSION: We report high incidence of anti-tubercular and antiretroviral DILI in Ethiopian patients. Between patient variability in systemic efavirenz exposure and pharmacogenetic variations in NAT2, CYP2B6 and ABCB1 genes determines susceptibility to DILI in TB-HIV co-infected patients. Close monitoring of plasma efavirenz level and liver enzymes during early therapy and/or genotyping practice in HIV clinics is recommended for early identification of patients at risk of DILI.

Project description:BackgroundIsolated or multi lineage cytopenia are the most common clinicopathological features and independently associated with increased risk of disease progression and death among human immunodeficiency virus infected children. In the study area, there is scarcity of data about the magnitude of various cytopenia.ObjectivesAimed to determine the magnitude and associated factors of peripheral cytopenia among HIV infected children at the University of Gondar Specialized Referral Hospital ART clinic, Northwest Ethiopia.MethodsInstitutional based cross-sectional study was conducted on 255 HIV infected children from January- April 2020. None probable convenient sampling technique was used to select the study participant. Socio demographic data were collected by pre tested structured questionnaire via face-to-face interview and their medical data were obtained from their follow-up medical records. Moreover, blood specimens were collected and examined for complete blood count, viral load and blood film, whereas stool specimens were collected and examined for intestinal parasites. Bi-variable and multi-variable logistic regression models were fitted to identify associated factors of cytopenia. P-Value <0.05 was considered as statistically significant.ResultThe overall magnitude of peripheral cytopenia was 38.9%. Anemia, leukopenia, lymphopenia, thrombocytopenia and bi-cytopenia were 21.2%, 12.2%, 11%, 1.6% and 3.9% respectively. Being in the age group of 2-10 years (AOR = 5.38, 95%CI 2.33-12.46), AZT based regimen (AOR = 5.44, 95%CI: 2.24-13.21), no eating green vegetables (AOR = 2.49, 95% CI: 1.26-4.92) and having plasma viral load >1000 copies /ml (AOR = 5.38, 95%CI: 2.22-13.03) showed significant association with anemia.ConclusionAnemia was the predominant peripheral cytopenia among HIV infected children in this study. It was strongly associated with AZT based drug type, age below 10 years and high viral load. Critical stress should be given for early investigation and management of cytopenia in addition to the use of alternative drug which leads to higher viral suppression and lower risk of toxicity issue.

Project description:Asymptomatic pharyngeal colonization by potential bacteria is the primary reservoir for bacterial species within a population and is considered a prerequisite for development of major childhood diseases such as sinusitis, otitis media, pneumonia, bacteremia, and meningitis. However, there is dearth of data on the colonization and drug resistance pattern of the main bacterial pathogens in the pharynx of HIV infected children in Ethiopia. Therefore, this study determined the pharyngeal colonization and drug resistance profile of bacterial pathogens in HIV infected children attending ART clinic of Felegehiwot Referral Hospital (FHRH), Amhara Region, Ethiopia.A hospital based cross-sectional study was conducted from May 2016 to June 2017 at the ART clinic of FHRH. A total of 300 HIV infected children were enrolled in the study. Data on socio-demographic characteristics of the study participants were collected with face-to-face interview and patient-card review using structured questionnaire. Bacterial species were identified using standard bacteriological techniques. Drug susceptibility testing was performed using disk diffusion technique. Chi-square test was done to determine associations among variables.The median age of the participants was 11 years. Overall, 153 (51%) of children were colonized by respiratory bacteria in their pharynx. Colonization rate was higher in children from mothers who had attained college and above levels of education than others (P = 0.04). It was also higher in children without the sign of malnutrition than others (P = 0.004). The colonization rate of S.aureus, M.catarrhalis, S.pneumoniae and H.influenzae were 88 (29%), 37 (12.3%), 31 (10.3%) and 6 (2%), respectively. S.aureus-M.catarrhalis concurrent colonization was found in 14 (4.7%) of children. Age (P = 0.03), schooling (P = 0.045) and history of running nose (P = 0.043) were significantly associated with S.aureus colonization. Living in urban setting (P = 0.042) and children from mothers with college and above levels of education (P = 0.002) were significantly associated with M.catarrhalis colonization. Majority of the isolates were resistant to penicillin (68.5%) and cotrimoxazole (52.5%).S.aureus isolates were resistant to penicillin (84.1%) and cotrimoxazole (51.1%).M.catarrhalis isolates were resistant to penicillin (94.6%), erythromycin (86.5%)and cotrimoxazole (78.4%). Overall, 99 (59.3%) of the isolates were multi-drug (MDR) resistant. The overall MDR rates among S.aureus, M.catarrhalis and S.pneumoniae isolates were 65.9%, 78.4% and 22.6%, respectively.Pharyngeal colonization of respiratory bacteria in HIV infected children is a major public health problem. Single and multiple antibiotic resistant is alarmingly high among respiratory colonizers. Therefore, regular screening of HIV infected children for culture and antimicrobial susceptibility testing is recommended to prevent the development of severe opportunistic infections.

Dataset Information

Drug-induced hepatotoxicity among TB/HIV co-infected patients in a referral hospital, Ethiopia.

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Drug-induced hepatotoxicity among TB/HIV co-infected patients in a referral hospital, Ethiopia.

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