Journal of Postgraduate Medicine
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Year : 2014  |  Volume : 60  |  Issue : 2  |  Page : 225-226  

Risk factors for drug-induced hepatitis with first-line antituberculosis drugs in hospitalized patients of pulmonary tuberculosis

SM Pore1, KB Shinde2,  
1 Department of Pharmacology, Government Medical College, Miraj, Maharashtra, India
2 Shri Chhatrapati Shivaji Maharaj Sarvopchar Rugnalaya, Solapur, Maharashtra, India

Correspondence Address:
Dr. S M Pore
Department of Pharmacology, Government Medical College, Miraj, Maharashtra

How to cite this article:
Pore S M, Shinde K B. Risk factors for drug-induced hepatitis with first-line antituberculosis drugs in hospitalized patients of pulmonary tuberculosis.J Postgrad Med 2014;60:225-226

How to cite this URL:
Pore S M, Shinde K B. Risk factors for drug-induced hepatitis with first-line antituberculosis drugs in hospitalized patients of pulmonary tuberculosis. J Postgrad Med [serial online] 2014 [cited 2022 May 26 ];60:225-226
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We appreciate the comments on our paper and accept them and the flawed analysis. A new univariate analysis is now presented in [Table 1]. The primary reason for selecting previous antituberculosis therapy (ATT) as a risk factor rather than previous history of hepatitis was our dependence on recorded data. This study being retrospective and record-based, we had a limited choice of risk factors. Previous ATT was deemed as a risk factor because the exact mechanism of drug induced liver toxicity is poorly understood; it may result from direct toxicity of the primary compound, a metabolite, or from an immunologically mediated response, affecting hepatocytes, biliary epithelial cells, and/or liver vasculature. [1] It is well known that immunological response is affected by previous exposure. There is previous literature to support this. [2] In the new univariate analysis, the odd's ratio (OR) for previous ATT is less than one. However, an OR value below 1.00 is not directly interpretable. [3] The OR for females developing DIH is now calculated to be 0.958 as against the previous value of 2.515. Considering 257 patients of HIV co-infection for whom data were available, it was thus not a significant risk factor in this study. Though HIV testing is advised to all tuberculosis patients to facilitate early detection of HIV infection, it is voluntary, not mandatory. Central TB division (CTD) and the National AIDS Control Organization (NACO) have adopted the policy of routinely offering voluntary HIV counselling and testing to all TB patients. [4] It is important to note that depending on the definition of drug induced hepatitis, HIV infection may or may not be associated with antituberculosis-drug-induced hepatotoxicity. [5] We agree that identification of previous ATT and female gender as risk factors in the earlier paper were flawed. Alcohol abuse is the only significant risk factor in new univariate analysis carried out.{Table 1}


We are grateful to Dr. Jadhav SL, Professor in Community Medicine, Pd Dr. DY Patil Medical College, Pimpri, Pune for his valuable guidance.


1Saukkonen JJ, Cohn DL, Jasmer RM, Schenker S, Jereb JA, Nolan CM, et al.; ATS (American Thoracic Society) Hepatotoxicity of Antituberculosis Therapy Subcommittee. An official ATS statement: Hepatotoxicity of antituberculosis therapy. Am J Respir Crit Care Med 2006;174:935-52.
2Schaberg T, Rebhan K, Lode H. Risk factors for side-effects of isoniazid, rifampin and pyrazinamide in patients hospitalized for pulmonary tuberculosis. Eur Respir J 1996;9:2026-30.
3McHugh ML. The odds ratio: Calculation, usage, and interpretation. Biochem Med (Zagreb) 2009;19:120-6. Available from: [Last accessed on 2014 Apr 7].
4National AIDS Control Organization and Central TB Division, Ministry of Health and Family Welfare Government of India. Training Manual on Intensified TB/HIV package for NACP and RNTCP Programme Managers and Supervisors at State and District level Dec 2009. Available from: [Last accessed on 2014 Apr 10].
5Coca NS, Oliveira MS, Voieta I, Antunes CM, Lambertucci JR. Antituberculosis drug-induced hepatotoxicity: A comparison between patients with and without human immunodeficiency virus seropositivity. Rev Soc Bras Med Trop 2010;43:624-8.

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