ABSTRACT
Introduction: The prevalence of rifampicin, isoniazid and pyrazinamide induced elevations in serum alanine aminotransferase (ALT) levels were compared in a cohort of Nigerians with and without HIV seropositivity. Methods: Records of all the patients with pulmonary tuberculosis (251 HIV positive and 205 HIV negative), aged above 15 years treated in the TB program of the Federal Medical Centre, Yenagoa from January 2013 to December 2014 were analysed for this study. The WHO 4 grades of hepatotoxicity using ALT were used. ALT of less than 50 U/L was taken as normal. Grade 1 (very mild hepatotoxicity): <2.5 x upper limit of normal (ULN) i.e. ALT 51-125 U/L. Grade 2 (mild): 2.6 – 5 x the ULN (ALT 126-250 U/L). Grade 3 (moderate): 5-10 x the ULN (ALT 251 – 500 U/L). Grade 4 (severe) >10 x the ULN (ALT > 500 U/L). Results: No patient with or without HIV seropositivity had ALT value in the grade 3 and 4 category ≥251 U/L. There was no statistically significant difference in ALT values between cohorts with or without HIV in the 3 ALT categories obtained while on antituberculous drugs (P = 0.761, 0.367 and 0.197). Conclusion: All the observed hepatotoxicity were mild. The average rate of hepatotoxicity in the HIV uninfected pulmonary tuberculosis cohort was 16.6%, 9.8% and 5.4% for ALT1, ALT2 and ALT3 respectively. The rate in the HIV infected cohorts was 15.5%, 8.8% and 16.4% for ALT1, ALT2 and ALT3. It is encouraging to find a low rate of antituberculosis drug induced hepatotoxicity than one would expect based on the high prevalence of risk factors in our environment.
ABSTRACT
Background: This study, undertaken in a major tertiary hospital in the Niger Delta region of Nigeria, was designed to examine the incidence of lower lung field tuberculosis in HIV infected and uninfected patients, and in diabetic patients as well as their AFB status and outcome of treatment. Methods: Between January 2011 and December 2013, admission records, HIV status, chest radiographs findings, blood glucose levels and AFB status of all pulmonary tuberculosis patients seen in our hospital were retrieved and retrospectively analyzed according to HIV status, AFB status, chest radiographs findings and blood glucose levels. All the patients with pulmonary tuberculosis who had lesions below an arbitrary line across the hila region in their chest PA radiograph were included in the study as cases of lower lung field tuberculosis. Results: Of the 596 pulmonary tuberculosis patients reviewed, 76 (12.8%) had lower lung field tuberculosis. It was more common in females (14.1%) than in males (10.9%). Majority of the patients (57.9%) were in the 24-34 years age groups. HIV infected cases had significantly higher occurrence at 46.4%. Diabetic patients had an incidence of 15.0%. Bilateral disease was more common (74.6%) and when unilateral the right side was more affected (51.4%). The main radiological findings were cavitation (44.7%), fibrosis (30.6%) and nodular opacities (22.3%). Conclusion: HIV infection and diabetes mellitus increase the risk of lower lung field pulmonary tuberculosis.