Rechallenge after anti-tuberculosis drug-induced liver injury in a high HIV prevalence cohort

Southern African Journal of HIV Medicine

Field Value
Title Rechallenge after anti-tuberculosis drug-induced liver injury in a high HIV prevalence cohort
Creator Moosa, Muhammed Shiraz Maartens, Gary Gunter, Hannah Allie, Shaazia Chughlay, Mohamed F. Setshedi, Mashiko Wasserman, Sean Stead, David F. Cohen, Karen
Subject — tuberculosis; anti-tuberculosis drugs; drug-induced liver injury; positive rechallenge; pyrazinamide; treatment interruption
Description Background: 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: To describe the outcomes of rechallenge with first-line ATT.Method: 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: 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 (P = 0.005), female sex (P = 0.039) and first episode of tuberculosis (TB) (P = 0.032).Conclusion: Rechallenge was successful in most of our cohort. Pyrazinamide rechallenge should be carefully considered.
Publisher AOSIS
Date 2022-06-14
Type info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion — —
Format text/html application/epub+zip text/xml application/pdf
Identifier 10.4102/sajhivmed.v23i1.1376
Source Southern African Journal of HIV Medicine; Vol 23, No 1 (2022); 5 pages 2078-6751 1608-9693
Language eng
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Rights Copyright (c) 2022 Muhammed Shiraz Moosa, Gary Maartens, Hannah Gunter, Shaazia Allie, Mohamed F. Chughlay, Mashiko Setshedi, Sean Wasserman, David F. Stead, Karen Cohen