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Human and Clinical Nutrition
Abbreviations: BW, body weight; DIH, drug-induced hepatotoxicity; HBV, hepatitis B virus; HCV, hepatitis C virus; MDR-TB, multi-drug-resistant tuberculosis; TB, tuberculosis
Drug-induced hepatotoxicity (DIH) is a well-known complication in the treatment of tuberculosis (TB). This may sometimes require interruption of therapy with anti-TB drugs. Incidence of hepatotoxicity during treatment of TB disease varies from 5 to 33 %. It depends on the study population, definition of hepatotoxicity, anti-TB drugs used, and the way of monitoring(1). Many factors have been associated with DIH. These include TB morbidity(2-5), co-infections such as HIV and hepatitis B and C(6-12), malnutrition(4,13), old age(14), female sex(2,4,15), elevated transaminases at baseline(14,16-18), and high alcohol intake(3,6).
Malnutrition, as assessed by a low BMI, has been associated with the occurrence of TB-DIH in two studies(4,13). BMI at the start of TB treatment is a frequently used static nutritional risk factor in TB research(19,20). Body weight (BW) change after the start of TB treatment may reflect an improving or a worsening nutritional status during TB treatment. In this study we intended to assess the link between this BW change and drug-induced liver toxicity necessitating interruption of anti-TB drugs.
Methods
Patients
A retrospective review of patients records, admitted between January 2005 and July 2008 at TB Centre Beatrixoord of University Medical Center Groningen, Netherlands, was conducted. All patients>14 years of age diagnosed with active Mycobacterium tuberculosis infection(21) were included. Interrupters were patients who had to stop one or more anti-TB drugs for reasons of hepatotoxicity based on international guidelines(1,22).
Controls (non-interrupters) were all other patients admitted during the same study period. The following data about the cases were collected: age, sex, addictions, time to interruption, nutritional status, morbidity, medication and drug sensitivity test results. Because this was a retrospective chart review with anonymised reporting, approval by the ethics...