CLINICAL PREDICTORS AND RISK FACTORS OF ANTI-TUBERCULOSIS DRUG-INDUCED LIVER INJURY IN PATIENTS WITH HIV/TUBERCULOSIS CO-INFECTION

Matin Abdul, Nikitin Igor Gennadievich

Drug-induced liver injury remains a serious complication of anti-tuberculosis therapy in patients with human immunodeficiency virus and tuberculosis co-infection. A prospective cohort study was conducted involving 412 patients with newly diagnosed co-infection who received standard first-line anti-tuberculosis therapy. A comprehensive assessment of clinical, laboratory, demographic, and immunological parameters was performed. Genotyping of polymorphisms in drug-metabolizing enzyme genes was carried out by polymerase chain reaction. The incidence of drug-induced liver injury was 11.4 percent. Independent predictors were CD4 lymphocyte count below 200 cells per microliter, body mass index below 18.5 kilograms per square meter, concurrent use of hepatotoxic antiretroviral agents, and elevated baseline alanine aminotransferase. Slow acetylator status of N-acetyltransferase 2 was associated with a fourfold increase in hepatotoxicity risk. The predictive model demonstrated an area under the ROC curve of 0.843, indicating high predictive ability. A slow acetylator status of N-acetyltransferase 2 was associated with a fourfold increase in the risk of hepatotoxicity. The developed comprehensive predictive model demonstrated an area under the ROC curve of 0.843, indicating high predictive ability.

Keywords:drug-induced liver injury; HIV/tuberculosis co-infection; clinical predictors; anti-tuberculosis therapy; antiretroviral therapy; predictors of hepatotoxicity; internal medicine