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Free Content Can hepatitis B virus infection predict tuberculosis treatment liver toxicity? Development of a preliminary prediction rule

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BACKGROUND: Liver toxicity due to tuberculosis (TB) treatment is a frequent cause of treatment interruption, and may sometimes lead to a change in therapy to a less potent regimen.

OBJECTIVE: To estimate the risk of hepatotoxicity in patients with or without hepatitis B virus (HBV) infection receiving TB treatment and to develop a clinical prediction rule.

DESIGN: A prospective observational follow-up was conducted. Data from 154 patients who underwent TB treatment were analysed. Crude risk ratios were estimated and a Cox proportional hazards model was fit.

RESULTS: The mean follow-up time was 187 days. Crude risk ratios showed that ethnicity, human immunodeficiency virus infection, multiple sexual partners, highly active antiretroviral treatment, and clinical forms of TB were possible predictors of liver toxicity. HBV infection and other sexually transmitted diseases showed considerable relative risk, although not statistically significant. The Cox proportional hazards model identified the following predictors of hepatotoxicity: White ethnicity, multiple sexual partners, high baseline alanine transferase and clinical forms of TB. Active HBV, indicated by the detection of surface antigen HBV, could predict hepatotoxicity, although with low precision.

CONCLUSION: Using this information, we were able to apply a score and draw a nomogram to estimate survival probabilities and median times to event for each patient.
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Keywords: HIV; anti-tuberculosis agents; drug toxicity; hepatitis B; nomograms; tuberculosis

Document Type: Regular Paper

Affiliations: Instituto de Pesquisa Clinica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Rio de Janeiro, Brazil

Publication date: 01 March 2010

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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