He incidence of anti-tuberculosis drugs induced Hepatotoxicity and associated risk factors among Tuberculosis patients in dawro zone, south ethiopia: a Cohort stu

Abstract

Background: Anti-tuberculosis drugs causes hepatotoxicity in some individuals leading to acute liver failure which results in death. Such phenomena limit the clinical use of drugs, contributing to treatment failure that possibly causes drug resistance. Furthermore, associated risk factors for the development of anti-tuberculosis-drug induced hepatotoxicity are found to be controversial among different study findings. Objective: To determine the incidence rate of anti-tuberculosis drug induced hepatotoxicity and associated risk factors among tuberculosis patients in Dawro zone, southern Ethiopia. Method: A prospective cohort study was conducted from 1 May to 30 October2014 in Dawro zone Tercha district hospital laboratory.124 new tuberculosis positive individuals available from Tercha hospital and 5 health centers during data collection were consecutively included. Socio demographic data and anthropometric measurement was obtained.5 ml of venous blood was drawn from each individuals and Alanine amino transferase, Aspartate amino transferase and total bilirubin was measured photometricallyat baseline and then continuously monitored by measuring these liver enzymes every two weeks for two months. Data was analyzed with statistical package for social science (version 20 Chicago inc.).Logistic regression, (odds ratios) with 95% confidence intervals was calculated to evaluate the possible association of all variables. P-value of less than 0.05 was considered as statistically significant. Result: The incidence of anti-tuberculosis induced hepatotoxicity was found to be 8% (10 patients out of 124). Raised serum transaminase and bilirubin level as well as sign and symptoms of hepatotoxicity(nausea,anorexia, vomiting,malaise, and jaundice) were observed in the cases. The onset of hepatotoxicity ranged from 13-58 days (median: 26 days) aftertreatment was initiated.Of the various risk factors analyzed, only high alcohol intake was associated with the incidence (OR=9.3, 95% CI (1.8-47),P<0.007). Age, sex, extent of tuberculosis and malnutrition were not significantly associated with anti-tuberculosis induced hepatotoxicity.2 Conclusion:The incidence of anti-tuberculosis induced hepatotoxicity in Dawro zone was high.The drug responsible for the hepatotoxicity was not known.However chronic high alcohol intake was associated with the development of anti-tuberculosis induced hepatotoxicity.