埃塞俄比亚艾滋病毒阳性和阴性患者中抗结核治疗引起的肝毒性
Anti-tuberculosis therapy-induced hepatotoxicity among Ethiopian HIV-positive and negative patients.
作者信息
Yimer Getnet, Aderaye Getachew, Amogne Wondwossen, Makonnen Eyasu, Aklillu Eleni, Lindquist Lars, Yamuah Lawrence, Feleke Beniyam, Aseffa Abraham
机构信息
Armauer Hansen Research Institute, Addis Ababa, Ethiopia.
出版信息
PLoS One. 2008 Mar 19;3(3):e1809. doi: 10.1371/journal.pone.0001809.
BACKGROUND
To assess and compare the prevalence, severity and prognosis of anti-TB drug induced hepatotoxicity (DIH) in HIV positive and HIV negative tuberculosis (TB) patients in Ethiopia.
METHODOLOGY/PRINCIPAL FINDINGS: In this study, 103 HIV positive and 94 HIV negative TB patients were enrolled. All patients were evaluated for different risk factors and monitored biochemically and clinically for development of DIH. Sub-clinical hepatotoxicity was observed in 17.3% of the patients and 8 out of the 197 (4.1%) developed clinical hepatotoxicity. Seven of the 8 were HIV positive and 2 were positive for HBsAg.
CONCLUSIONS/SIGNIFICANCE: Sub-clinical hepatotoxicity was significantly associated with HIV co-infection (p = 0.002), concomitant drug intake (p = 0.008), and decrease in CD4 count (p = 0.001). Stepwise restarting of anti TB treatment was also successful in almost all the patients who developed clinical DIH. We therefore conclude that anti-TB DIH is a major problem in HIV-associated TB with a decline in immune status and that there is a need for a regular biochemical and clinical follow up for those patients who are at risk.
背景
评估并比较埃塞俄比亚HIV阳性和HIV阴性结核病（TB）患者中抗结核药物所致肝毒性（DIH）的患病率、严重程度及预后。
方法/主要发现：本研究纳入了103例HIV阳性和94例HIV阴性的TB患者。对所有患者评估不同的危险因素，并对DIH的发生进行生化和临床监测。17.3%的患者观察到亚临床肝毒性，197例中有8例（4.1%）发生临床肝毒性。8例中的7例为HIV阳性，2例HBsAg阳性。
结论/意义：亚临床肝毒性与HIV合并感染（p = 0.002）、同时服用其他药物（p = 0.008）及CD4细胞计数下降（p = 0.001）显著相关。几乎所有发生临床DIH的患者逐步重新开始抗结核治疗均获成功。因此我们得出结论，抗结核DIH是HIV相关结核病中的一个主要问题，且免疫状态下降，对于有风险的患者需要定期进行生化和临床随访。
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