Risk of drug-induced liver injury in patients with pulmonary tuberculosis and chronic viral hepatitis: systematic review and meta-analysis

• Anastasiia V. Kukurika
• Irina A. Vasilyeva

Abstract

Antituberculosis drug-induced liver damage represents a major safety concern in tuberculosis (TB) treatment. The impact of chronic viral hepatitis (CVH) on the risk of hepatotoxicity is still controversial.

The aim is the systematic review and meta-analyze published studies evaluating drug-induced liver injury (DILI) in patients with TB/CVH co-infection, receiving chemotherapy for TB.

Material and methods. We searched for publications by the given keywords in MEDLINE (PubMed), Google Scholar and eLibrary electronic databases. Twelve publications with a total number of 5338 patients were selected for meta-analysis, among which 986 patients had TB/CVH co-infection. Meta-analysis was performed using Review Manager software (RevMan version 5.4; Cochrane Collaboration, Oxford, United Kingdom). Statistical heterogeneity of studies was checked using a Q-test based on χ². A random-effects model was adopted when p<0.1 in the χ² test and I² >40%, a fixed-effect model when p≥0.1 in the χ² test and I² ≤40%.

Results and discussion. According to the meta-analysis, the incidence of DILI in patients with TB/CVH co-infection was found to be higher than in the group without CVH and amounted to 27%, as confirmed by the meta-analysis odds ratio (OR) 2.66 [95% confidence interval (CI) 1.9–3.73]. Hepatitis C virus carriers had a higher risk of developing DILI than hepatitis B virus carriers OR=3.61 (95% CI 2.69–4.86).

Conclusion. The results of this meta-analysis show that patients with tuberculosis/chronic viral hepatitis coinfection who received antituberculosis treatment have a higher risk of developing DILI than patients without chronic viral hepatitis. Patients with chronic hepatitis C were found to be at higher risk of hepatotoxicity than patients with chronic hepatitis B. This study emphasizes the importance of biochemical monitoring in patients with chronic viral hepatitis before and during antituberculosis treatment.

Keywords: tuberculosis; chronic viral hepatitis; drug-induced liver injury; hepatotoxicity

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