Hepatotoxic Effects of Anti-Tuberculosis Medications: A Clinical Assessment

Abstract

Background: Tuberculosis (TB) is a contagious disease that is highly prevalent worldwide. Every year, Mycobacterium tuberculosis causes over 2 million fatalities and about 8 million new cases of active tuberculosis. Treatment for adult respiratory TB is a regimen of isoniazid, Rifampicin, and pyrazinamide for 2 months, followed by 4 months of isoniazid and Rifampicin. All these anti-TB medications have the potential to be hepatotoxic, but when used together, the toxicity is amplified synergistically. Drug-induced Liver Injury (DILI) is defined as a liver injury due to Xenobiotics, herbs, or medications that lead to either liver dysfunction or abnormal liver serology in the setting of no other identifiable cause. Serum biomarkers, including ALT AST, ALP, and T. Bilirubin, are routinely utilized in diagnoses and therapeutic outcome assessments of DILI in the clinic. The purpose of the study was to assess the hepatotoxicity effect of anti-tuberculosis medications. Methods: This study was observational. The data was collected from Sayyed Muhammad Hussain Government TB sanatorium, Samli Murree. This study was conducted from October 2023 to December 2023. A non-probability sampling technique was used for this research. Eighty-two random TB patients who were using antitubercular drugs for their treatment and had done their Liver Function Tests (LFTs) were selected. The data is presented in the form of tables and pie charts. Results: About 135 LFT reports of 82 TB patients were found with varying parameters. Throughout their course of therapy, 24% of patients developed ATT-induced hepatitis, 6% of patients merely had elevated bilirubin levels, 1% of patients had elevated ALP, 2% of patients had HCV+, and 1% patients had HbAg+. However, 65.80% of patients maintained normal liver function. This study found that the harmful effects of drugs also come along with treatment, which healthcare professionals shouldn't neglect. It showed the adverse effects of antitubercular drugs on the liver. Therefore, drug therapy must be stopped immediately after noticing any abnormal changes in the liver profile. Conclusion: In conclusion, anti-tuberculosis treatment has a notable impact on hepatocellular injury, with a significant proportion of patients experiencing elevated liver enzymes and bilirubin levels indicative of liver stress or damage. The treatment was associated with drug-induced hepatitis in some patients, reflecting its potential to cause hepatocellular injury, particularly in those with predisposing factors. These findings highlight the importance of regular monitoring of liver function tests during therapy to detect and manage hepatocellular injury promptly, ensuring a balance between effective tuberculosis treatment and the prevention of serious liver complications.