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Free Content Age-related risk of hepatotoxicity in the treatment of latent tuberculosis infection: a systematic review [Review article]

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OBJECTIVE: To determine the age-related risk of hepatotoxicity under currently recommended treatment regimens for latent tuberculosis (TB) infection (LTBI).

METHODS: A systematic review of the MEDLINE and EMBASE databases (from database inception to 2008) was performed to determine the risk of isoniazid (INH) and/or rifampicin hepatotoxicity in LTBI treatment stratified by patient age. Study selection, study quality assessment and data extraction were performed using piloted proformas. Rate data were meta-analysed to generate summary rates with 95%CI within age-related subgroups using a random effects model.

RESULTS: Seven relevant studies (18 610 participants, including 115 cases of hepatotoxicity) met the selection criteria. The median rate of hepatotoxicity was 1.8% (range 0.07–11.9). On average, rates were higher among those aged ≥35 years (1.7%, 95%CI 1.4–2.2) than those aged <35 years (0.2%, 95%CI 0.1–0.3).

CONCLUSION: The rates of hepatotoxicity were low. Summary estimates of risks generated in this review can be used for counselling individuals for whom chemoprophylaxis is recommended. The use of INH for the treatment of LTBI is safe in older patients with clinical or biochemical monitoring.
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Keywords: hepatotoxicity; isoniazid; systematic review; tuberculosis

Document Type: Review Article

Affiliations: 1: Department of Respiratory Medicine, Heartlands Hospital, Birmingham, UK 2: School of Clinical and Experimental Sciences, University of Birmingham, Birmingham, UK

Publication date: 01 November 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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