Drug-related toxicity of HIV patients on antiretroviral and tuberculosis therapy

Abstract

Background: There are large numbers of people on both antiretroviral therapy (ART) and tuberculosis (TBT) therapy in South Africa due to the burden of disease. Both treatments may have overlapping toxicities resulting in drug induced liver injury (DILI) and drug induced renal injury (DIRI) which impacts on both morbidity and mortality in HIV patients. Objectives: To determine the incidence, expression, severity and risk factors of DILI and DIRI, as well as to determine the effect of DILI and DIRI on the length of hospital stay in a large HIV patient cohort receiving ART alone, TBT alone or concomitant TBT and ART . Methods: A retrospective descriptive study was conducted on primary data obtained from the Infectious Diseases division database of patients who were admitted at Helen Joseph Hospital (HJH) from 1 January 2013 to 30 June 2015. Data collected included socio-demographic, treatment regimen, and laboratory variables. Descriptive statistics and association of the variables were studied. Ordered logistic regression was used to analyse the predictors for the incidence of DILI and DIRI. Results: Thirty per cent of patients with liver impairment (102/342) were classified as DILI. ART alone (41.2%) and combination of TBT and ART (42.2%), had a greater contribution to the development of DILI compared to TBT alone (16.7%). The predominant expression and severity grading of DILI were cholestasis (59.5%) and mild injury (58.8%), respectively. Only 10% (32/333) of patients with renal disease, were classified as DIRI. ART (62.5%) and combination of ART and TBT (34.4%) were important contributors to the incidence of DIRI. Pure TB therapy had a little role in this regard (n=1). The significant predictors for DILI were age, female sex and length of hospital stay, while that for DIRI was baseline creatinine. Conclusion: DILI was more common than DIRI in the study. ART alone and combination of TBT and ART, had a greater contribution to the development of DILI and its severity compared to TBT alone. Both ART and combination of ART and TBT treatment were important contributors to the incidence of DIRI. Pure TB therapy had little role in this regard. There is an important need for prospective studies to investigate the incidence and outcomes of DILI and DIRI.