Burden of antituberculosis and antiretroviral drug-induced liver injury at a secondary hospital in South Africa
Master Thesis
2012
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University of Cape Town
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Abstract
Aims : 1. To determine the proportion of patients who present with TB treatment and or ART-associated drug-induced liver injury (DILI) amongst all patients presenting with significant liver injury to GF Jooste Hospital during the study period. 2. To describe base line clinical characteristics and management of TB treatment and or ART-associated DILI patients. 3. To describe the in-patient and 3-month mortality of TB treatment and or ART-associated DILI patients. Background and Rationale : GF Jooste Hospital is a public sector referral hospital and serves a densely populated area with a high burden of HIV and tuberculosis (TB). ART rollout in the Western Cape started in 2001/2002 at two pilot clinics and is now well established (1). Many patients are on concomitant TB treatment and ART. At ART clinics in the referral area 25 - 40% of patients are on TB treatment when they start ART (2, 3) . At GF Jooste hospital many HIV positive patients are seen who are on TB treatment and or ART, and present with symptomatic liver dysfunction. Patients are on multiple hepatotoxic drugs, may have multiple opportunistic infections, systemic sepsis and hepatic TB immune reconstitution disease also plays a role. Anecdotally, these patients are complex to manage, require frequent specialist input, spend a long time in hospital and have high mortality. Management guidelines are based on expert opinion and is not evidence based. In practice management relies heavily on the attending clinicians’ experience and clinical judgment and management often differ widely between clinicians. Mortality could be due to progression of TB and or HIV because of interruption of effective therapy, other opportunistic infections or hospital acquired infections. Few early liver biopsies are done and it is not known if early liver biopsies would aid by guiding management of these patients. Prospective studies are urgently needed to guide management in these patients. The burden of TB treatment and or ART-associated drug induced liver injury in this setting has not been described to our knowledge, neither has management, outcome or mortality. This study was performed to aid planning of prospective studies in this field.
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Includes bibliographical references.
Reference:
Schutz, C. 2012. Burden of antituberculosis and antiretroviral drug-induced liver injury at a secondary hospital in South Africa. University of Cape Town.