STUDY OF LIVER FUNCTION ABNORMALITIES IN THE TUBERCULOSIS PATIENTS UNDERGOING RNTCP- DOTS IN TB CLINIC MADURAI

Dr. C. Thomas Kingsley, MD; DTCD and *Dr. T. Grashia, MD

ABSTRACT

Introduction: India accounts for nearly one fifth of the global burden of tuberculosis. India has more new TB cases annually than any other country in the world. The obstacles to success to include poor patient compliance, drug resistance, insufficient duration, and irregular therapy and last but not the least Drug induced Hepatotoxicity. DIH is the most unwanted side effect of ATT. Unfortunately almost all the chemotherapeutic agents used in tuberculosis cause hepatotoxicity by single or multiple mechanisms. Aims and Objectives: The aim of the study is to analyse the incidence of hepatotoxicity in patients taking anti-tuberculous drug therapy under the RNTCP short course schedule in Madurai district and also to analyse the various risk factors for development of hepatotoxicity. Materials and Methodology: A prospective study was conducted among 166 patients selected from amongst those who were registered in the Revised National Tuberculosis Control Programme (RNTCP) of Madurai medical college from June 2007 to June 2008 among which 156 were followed up for 6 months. Results and Discussion: Patients above 18 years with sputum positive tuberculosis and patients coming from within and nearby areas of Madurai were included in the study. Out of 156 patients who were followed up for 6 months, 88 were males and rest were females. The age group most commonly had disease was 15-39 yrs with mean age of 36.6years. Out of 156 patients who completed treatment 24 patients had increase in serum enzymes. Eight patients had symptomatic hepatitis. Patients in older age group, malnutrition and cavitary pulmonary tuberculosis disease had symptomatic hepatitis. Conclusion: Direct correlation existed between increasing ages, malnutrition, anaemia, advanced disease with sputum positivity and hypoproteinemia. Correction of the modifiable risk factors can lead to decrease in hepatotoxicity. Hepatotoxicity is usually self-limiting and treatment need not be discontinued permanently. Serial monitoring of liver function tests will help in early identification of drug induced hepatotoxicity and prevention of fulminant hepatic failure.

Keywords: Anti tubercular treatment (ATT), drug induced hepatotoxicity (DIH), liver function tests.