A Study to Detect Liver Enzyme Dysfunction among Patients on First Line Anti-Tubercular Drugs from RNTCP during the Course of Anti-TB Treatment.

ABSTRACT

Globally, an estimated 10.0 million people developed Tuberculosis in 2017. Side effects and toxicity of the first line anti-tubercular drugs were hepatotoxicity, skin rash, and joint pain. If hepatotoxicity develops on reintroduction of treatment with the same regimen, then treatment should be started with hepato-safe regimen. Majority of the reports have used an elevated Alanine Transaminase (ALT) or Aspartate Transaminase (AST) of 3 times upper limit of normal range (ULN) with symptoms attributable to liver injury or 5 times ULN of ALT or AST without symptoms to define hepatotoxicity. Due to paucity of studies regarding adaptive response, this study was conducted to find out the proportion of anti-tubercular drug (ATD) induced hepatitis during Anti-TB treatment and frequency of adaptive changes in Liver Enzymes during the course of anti TB treatment.METHODS116 patients who were diagnosed to have Pulmonary (PTB)/ Extrapulmonary (EPTB) tuberculosis at Outpatient & In-Patients of Department of Chest Medicine, Burdwan Medical College & Hospital, for eleven months after fulfilling the inclusion and exclusion criteria were included in the study. Treatment was given as per guidelines of Revised National TB Control Program.RESULTSIn 83.3% patients only SGPT level was elevated, while in 71% SGOT was only elevated. Both SGPT and SGOT were elevated in 66.7% of cases. Only 1.8% cases were observed with elevated SGPT and SGOT on six occasions. Only 16.7% had no elevation in SGPT and 28.9% had no elevation in SGOT. Most of the patients had asymptomatic elevation of liver enzymes and didn’t need any treatment interruption. 4.38% patients developed drug induced hepatitis and needed treatment interruption for about two weeks and all were reintroduced with the same regimen successfully.CONCLUSIONSDrug induced liver function abnormality is a common occurrence during the course of anti-TB treatment. Most patients show tolerance to anti-TB drugs and get adjusted after transient rise in liver enzymes. Concomitant use of hepatotoxic agent should be avoided as far as possible.