Rechallenge after anti-tuberculosis drug-induced liver injury in a high HIV prevalence cohort.
anti-tuberculosis drugs
drug-induced liver injury
positive rechallenge
pyrazinamide
treatment interruption
tuberculosis
Journal
Southern African journal of HIV medicine
ISSN: 2078-6751
Titre abrégé: South Afr J HIV Med
Pays: South Africa
ID NLM: 100965417
Informations de publication
Date de publication:
2022
2022
Historique:
received:
01
02
2022
accepted:
22
03
2022
entrez:
4
8
2022
pubmed:
5
8
2022
medline:
5
8
2022
Statut:
epublish
Résumé
There are limited data on the outcomes of rechallenge with anti-tuberculosis therapy (ATT) following anti-tuberculosis drug-induced liver injury (AT-DILI) in a high HIV prevalence setting. To describe the outcomes of rechallenge with first-line ATT. Hospitalised participants with AT-DILI who were enrolled into a randomised controlled trial of N-acetylcysteine in Cape Town, South Africa, were followed up until completion of ATT rechallenge. We described rechallenge outcomes, and identified associations with recurrence of liver injury on rechallenge (positive rechallenge). Seventy-nine participants were rechallenged of whom 41 (52%) were female. Mean age was 37 years (standard deviation [s.d.] ±10). Sixty-eight (86%) were HIV-positive, of whom 34 (50%) were on antiretroviral therapy (ART) at time of AT-DILI presentation. Five participants had serious adverse reactions to an aminoglycoside included in the alternate ATT regimen given after first-line ATT interruption: acute kidney injury in three and hearing loss in two. The median time from first-line ATT interruption to start of first-line ATT rechallenge was 13 days (interquartile range [IQR]: 8-18 days). Antiretroviral therapy was interrupted for a median of 32 days (IQR: 17-58) among HIV-positive participants on ART before AT-DILI. Fourteen participants had positive rechallenge (18%). Positive rechallenge was associated with pyrazinamide rechallenge ( Rechallenge was successful in most of our cohort. Pyrazinamide rechallenge should be carefully considered.
Sections du résumé
Background
UNASSIGNED
There are limited data on the outcomes of rechallenge with anti-tuberculosis therapy (ATT) following anti-tuberculosis drug-induced liver injury (AT-DILI) in a high HIV prevalence setting.
Objectives
UNASSIGNED
To describe the outcomes of rechallenge with first-line ATT.
Method
UNASSIGNED
Hospitalised participants with AT-DILI who were enrolled into a randomised controlled trial of N-acetylcysteine in Cape Town, South Africa, were followed up until completion of ATT rechallenge. We described rechallenge outcomes, and identified associations with recurrence of liver injury on rechallenge (positive rechallenge).
Results
UNASSIGNED
Seventy-nine participants were rechallenged of whom 41 (52%) were female. Mean age was 37 years (standard deviation [s.d.] ±10). Sixty-eight (86%) were HIV-positive, of whom 34 (50%) were on antiretroviral therapy (ART) at time of AT-DILI presentation. Five participants had serious adverse reactions to an aminoglycoside included in the alternate ATT regimen given after first-line ATT interruption: acute kidney injury in three and hearing loss in two. The median time from first-line ATT interruption to start of first-line ATT rechallenge was 13 days (interquartile range [IQR]: 8-18 days). Antiretroviral therapy was interrupted for a median of 32 days (IQR: 17-58) among HIV-positive participants on ART before AT-DILI. Fourteen participants had positive rechallenge (18%). Positive rechallenge was associated with pyrazinamide rechallenge (
Conclusion
UNASSIGNED
Rechallenge was successful in most of our cohort. Pyrazinamide rechallenge should be carefully considered.
Identifiants
pubmed: 35923608
doi: 10.4102/sajhivmed.v23i1.1376
pii: HIVMED-23-1376
pmc: PMC9257779
doi:
Types de publication
Journal Article
Langues
eng
Pagination
1376Informations de copyright
© 2022. The Authors.
Déclaration de conflit d'intérêts
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
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