Casualidade de lesão hepática induzida por medicamentos na coinfecção tuberculose/HIV

Abstract

Tuberculosis remains the most deadly infectious disease in the world. In People Living with HIV is the most common opportunistic disease, being the leading cause of hospitalization and death. Drug-Induced Liver Injury is a common liver disease that usually develops between one and 90 days after administration of the drug at usual doses. First-line drugs for the treatment of tuberculosis are known to be potential causes of drug-induced liver injury. The application of validated instruments to co-infected patients, aiming to identify liver injury, may be a way to enhance the therapeutic management of these patients. The aim of the study was to evaluate the causality of LHIM in the treatment of tuberculosis in drug-induced liver injury by the Naranjo and RUCAM instruments at a reference center in southeastern Brazil for infectious diseases. A retrospective cohort study was performed. Data were collected from medical records and laboratory reports of patients notified in the Notification Disease Information System for TB and the Human Immunodeficiency Virus from April 2015 to December 2018. Medical records and laboratory reports with potential for Evaluation of Drug-Induced Liver Injury, those with Alanine Aminotransferase and Alkaline Phosphatase levels above the upper normal limit after the introduction of tuberculosis treatment, using the Naranjo and RUCAM algorithms to determine causality. We included 160 patients, of which 76% (121/160) were male. Age ranged from 19 to 69 years, with a median of 41 years. Twenty-eight drug-induced liver injury events were observed during tuberculosis treatment, 92.9% (26/28) of which occurred within the first three weeks of initiation of anti-tuberculosis therapy. The classification of cholestatic liver injury was the most observed in the studied population (57.1%). Probable causal determination was the most observed by the Naranjo (39.3%) and RUCAM (42.9%) algorithms. Of the LHIM 39.3% were associated with the use of the basic treatment regimen for tuberculosis (rifampicin, isoniazid, pyrazinamide and ethambutol) followed by fluconazole (14.3%) and the combined fixed dose of tenofovir, lamivudine and efavirenz (10.7 %). The use of Naranjo and RUCAM algorithms has demonstrated the causality of Drug-Induced Liver Injuries, which can be a great aid in defining drug-associated injuries, thus contributing to their management process and collaborating in the health notification process.