Prevalence of and risk factors associated with hepatitis prior to treatment of new smear positive tuberculosis patients in the lower northern Thailand
The prospective study aimed to study prevalence of and risk factors associated with hepatitis prior to treatment of new smear positive tuberculosis patients, aged over 18 years in the lower north of Thailand. Stratified sampling method was used and a total of 413 patients were enrolled for participation in the study from 46 public hospitals in 5 provinces in the lower north region including Phitsanulok, Uttaradit, Phetchabun, Sukhothai and Tak Province. Data were analyzed using descriptive statistics, chi-square and odd ratio. It was found that the prevalence of hepatitis prior to treatment of tuberculosis was 6.5%. Factors related to the incidence of hepatitis before TB treatment were: (1) Behavioral factors: Patients who drank alcohol were 6.4 times more likely to develop hepatitis before treatment of tuberculosis. In addition, individuals who currently drink are 4.9 times more likely to develop non-severe hepatitis prior to TB treatment than those who do not drink or used to drink. (2) Genetic factors: Patients who have a family history of liver disease were 4.3 times more likely to develop hepatitis before TB treatment and 5.8 times more likely to develop non-severe hepatitis prior to TB treatment than those who do not have a family history of liver disease. (3) Demographic factors: Individuals with HIV infection were 8.6 times more likely to develop hepatitis before TB treatment 7.7 times more likely to develop non-severe hepatitis prior to TB treatment, and 12.4 times more likely to develop severe hepatitis prior to TB treatment than HIV-negative populations. The results of this study indicated that factors related to hepatitis before TB treatment are alcohol consumption, HIV infection and history of liver disease in the family. In response to findings from this study, an adjustment to Thailand’s current tuberculosis treatment and care guidelines is being proposed and it is recommended that liver function tests be performed before initiating treatment of tuberculosis for TB patients with history of alcohol abuse, HIV infection or history of liver disease in the family. As for policy recommendation, the Ministry of Public Health, Department of Disease Control, Bureau of Tuberculosis, National Health Security Office are advised to establish and implement the guidelines for treatment and care and benefits for tuberculosis patients at risk for developing hepatitis prior to receiving TB treatment.
2. Bureau of Tuberculosis. Thailand Operational Plan to End Tuberculosis 2017-2021. Bangkok: Aksorn Graphic and Design; 2017. (in Thai)
3. Department of Disease Control. Report of tuberculosis control in Thailand year 2009-2015. Bangkok: Bureau of Tuberculosis; 2016. (in Thai)
4. Bureau of Tuberculosis, Department of Disease Control. National Tuberculosis Control Programme Guideline, Thailand, 2018. Bangkok: Aksorn Graphic and Design; 2018. (in Thai)
5. Department of Medical Services, Ministry of Public Health. Clinical Practice Guideline (CPG) of Tuberculosis Treatment in Adult 2018. Bangkok: Beyond Enterprise; 2018. (in Thai)
6. Teleman MD, Chee CB, Earnest A, Wang YT. Hepatotoxicity of tuberculosis chemotherapy under general programme conditions in Singapore.The Int J Tuberc Lung Dis 2002;6: 699-705.
7. Suwankesawong W. Liver and biliary system disorder from tuberculosis drug: Health Product Vigilance System in Thailand (Thai vigibase). Medicinal and Health Product Bulletin 2001:14;61-5. (in Thai)
8. Thongraung W. Antituberculosis drug-induced hepatotoxicity: incidence, mechanism and management. Thai Pharmaceutical and Health Science Journal 2012;7:197-204 (in Thai)
9. Research Institute for Health Sciences, Chiang Mai University. Thai Drinking Survey Guide [Internet]. [cited 2017 Sep 17]. Available from: https://www.rihes.cmu.ac.th/CSAR/?p=306 (in Thai)
10. Office of the Alcohol Beverage Control Committee. Treatment and methods of stop drinking alcohol [Internet]. [cited 2018 Jul23]. Available from: https://www.thaiantialcohol.com/newsletters/view/7 (in Thai)
11. Lonjou C, Borot N, Sekula P, Ledger N, Thomas L, Halevy S, et al. A European study of HLA-B in Stevens-Johnson syndrome and toxic epidermal necrolysis related to five high-risk drugs. Pharmacogenet Genomics 2008;18:99-107.
12. Tariq S, Khan TS, Malik S, Anwar MS, Rashid A. Frequency of anti-tuberculous therapy-induced hep
13. atotoxicity in patients and their outcome. J Ayub Med Coll abbottabad 2009;21:50-2.
14. Singla R, Sharma SK, Mohan A, Makharia G, Sreenivas V, Jha B, et al. Evaluation of risk factors for antituberculosis treatment induced Hepatotoxicity. Indian J Med Res 2010;132:81-6.
15. Marzuki OA, Fauzi AR, Ayoub S, Kamarul Imran M. Prevalence and risk factors of anti-tuberculosis drug-induced hepatitis in Malaysia. Singapore Med J 2008;49:688-93.
16. Mohammed A Agha, Ibraheim I El-Mahalawy, Hosam M Seleem, Mohamed A Helwa. Prevalence of hepatitis C virus in patients with tuberculosis and its impact in the incidence of anti-tuberculosis drugs induced hepatotoxicity. Egypt J Chest Dis Tuberc 2015;64:91-6.
17. Kishore PV, Palaian S, Paudel R, Mishra P, Prabhu M, Shankar PR. Drug induced hepatitis with anti-tubercular chemotherapy: challenges and difficulties in treatment. Kathmandu Univ Med J 2007;5:256-60.
18. R M Fauzi, A Shah, M Y Rathor, S Satwi. Risk factors for anti tuberculous drugs induced hepatitis: a prospective survey from a chest clinic in a general hospital. Med J Malaysia 2004;59:72-7.
19. Aithal GP. Pharmacogenetic testing in idiosyncratic drug-induced liver injury: current role in clinical practice. Liver Int 2015;35:1801-8.
20. Matsumoto T, Ohno M, Azuma J. Future of pharmacogenetics-based therapy for tuberculosis. Pharmacogenomics 2014;15:601-7.
21. Subcommittee on Consideration of Treatment, Rehabilitation of Alcohol Addicts. Screening Guidelines for Treatment and Rehabilitation for People with Alcohol Drinking Problems. Bangkok: Aksorn Graphic and Design; 2018. (in Thai)
22. Classen CN, Warren R, Richardson M, Hauman JH, Gie RP, Ellis JH, et al. Impact of social interactions in the community on the transmission of tuberculosis in a high incidence area. Thorax [Internet]. 1999 [cited 2016 Aug 6];54:136-40. Available from: https://www. ncbi.nlm.nih.gov/pubmed/10325918
23. Kladphuang T, Chiewcharn T, Charoenpak R. Tuberculosis treatment regimens in patients experiencing liver toxicity due to short course chemotherapy at Bamrasnaradura Infectious Disease Institute between 2005-2009. Disease Control Journal 2012;38:306-17.
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