Mehta R, Ive P, Evans D, Menezes C N
Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
S Afr Med J. 2021 Apr 30;111(5):474-481. doi: 10.7196/SAMJ.2021.v111i5.15353.
South Africa (SA) has among the highest rates of HIV and tuberculosis (TB) in the world. Antituberculosis and antiretroviral treatment (ART) can cause drug-induced liver injury (DILI), consequences of which are disease relapse, treatment failure and drug resistance.
To: (i) determine the demographics of patients with DILI and the proportion of patients on antituberculosis drugs v. antiretroviral therapy or both; (ii) determine the median time to DILI after starting medication, and patterns of clinical presentation; (iii) determine the numbers of patients successfully re-challenged to initial therapy as inpatients; and (iv) determine the in-hospital mortality rate and predictors of all-cause mortality.
This was a retrospective record review of adult patients with DILI admitted to a tertiary hospital in Johannesburg, SA, between October 2015 and February 2017. Data on drug history, biochemical investigations and relevant imaging were collected.
The total sample was 129 records: 79 (61.2%) were males, 46 (35.7%) had TB DILI, 29 (22.5%) had ART DILI, and 54 (41.9%) had mixed TB/ART DILI. Only 7.4% (2/27) of those with ART DILI and 30.6% (11/36) with TB DILI were re-challenged to their original regimen by discharge. Patients were followed from admission until the earlier of death (10 with TB DILI, 2 with ART DILI and 9 with mixed DILI) or discharge (after a median (interquartile range) of 14.0 (9 - 23) days). In adjusted analysis, severe DILI at admission predicted all-cause mortality (adjusted hazard ratio 8.58; 95% confidence interval 1.13 - 65.4).
This study is one of only a few analyses of hospitalised patients with DILI in SA. Among those with severe DILI, outcomes are poor, the majority cannot tolerate standard regimens, and mortality is high.
南非是世界上艾滋病毒和结核病发病率最高的国家之一。抗结核和抗逆转录病毒治疗（ART）可导致药物性肝损伤（DILI），其后果包括疾病复发、治疗失败和耐药性。
（i）确定药物性肝损伤患者的人口统计学特征以及服用抗结核药物与接受抗逆转录病毒治疗或两者兼有的患者比例；（ii）确定开始用药后发生药物性肝损伤的中位时间以及临床表现模式；（iii）确定成功重新接受初始治疗的住院患者人数；（iv）确定住院死亡率和全因死亡率的预测因素。
这是一项对2015年10月至2017年2月期间入住南非约翰内斯堡一家三级医院的药物性肝损伤成年患者进行的回顾性病历审查。收集了用药史、生化检查和相关影像学数据。
总样本为129份记录：79例（61.2%）为男性，46例（35.7%）患有结核病药物性肝损伤，29例（22.5%）患有抗逆转录病毒治疗药物性肝损伤，54例（41.9%）患有混合性结核病/抗逆转录病毒治疗药物性肝损伤。出院时，只有7.4%（2/27）的抗逆转录病毒治疗药物性肝损伤患者和30.6%（11/36）的结核病药物性肝损伤患者重新接受了原治疗方案。患者从入院开始随访，直至死亡（10例结核病药物性肝损伤患者、2例抗逆转录病毒治疗药物性肝损伤患者和9例混合性药物性肝损伤患者）或出院（中位（四分位间距）为14.0（9 - 23）天）。在调整分析中，入院时严重药物性肝损伤可预测全因死亡率（调整后的风险比为8.58；95%置信区间为1.13 - 65.4）。
本研究是对南非住院药物性肝损伤患者进行的少数分析之一。在严重药物性肝损伤患者中，预后较差，大多数患者无法耐受标准治疗方案，死亡率较高。
