PROSPECTIVE ASSESSMENT OF CHRONIC HEPATITIS B INFECTION AND CHRONIC HEPATITIS C INFECTION AS A RISK FACTOR IN ANTI-TUBERCULAR DRUGS INDUCED LIVER INJURY PATIENTS IN A TERTIARY HEALTH CARE HOSPITAL AT DEHRADUN, UTTARAKHAND (INDIA)

Background: Anti-tubercular drug-induced liver injury (ATDILI) is a major safety concern for the treatment of tuberculosis (TB). The impact of chronic hepatitis B infection (CHBI) and chronic hepatitis C infection (CHCI) on the risk of ATDILI is still controversial. In this study, we aimed to assess systematically the influence of CHBI, CHCI on the susceptibility to ATDILI patients. Aims and objectives: To study of the Chronic Hepatitis B infection and Chronic Hepatitis C infection as a risk factor in anti-tubercular drug-induced liver injury: A Prospective observational study. Materials and method: Prospectively, we identified 24 cases of ATDILI among 172 patients diagnosed with confirmed pulmonary tuberculosis between July 2018 to December 2018.  None of the patients with established risk factor as ATDILI as recognized by ATS guidelines was included in our study population. Regular clinical and liver function test monitoring was done at the commencement of ATT. Results: Among these, 02 (8.3%) patients had hepatitis B virus (HBV) and 02 (8.3%) patients had hepatitis C virus (HCV), out of 24 ATDILI patients. Among the ATDILI cases, 03 patients had grade-1 DILI, 06 patients had grade-2 DILI, and 14 patients had grade-3 DILI, and 01 patients had grade-4 of the DILI cases fulfilled the ATS/BTS criteria for TB DILI. There were no human immunodeficiency virus (HIV) co-infected patients. Among the total 24 patients are developed the ATT induce hepatotoxicity. Among the total 24 patients anti tubercular drug induce hepatotoxicity cases, female patients 14 (8.13%) account for the highest number of risks ATDILI. Conclusion: This study suggests that CHBI, CHCI may increase the risk of ATDILI in the standard combination therapy for active TB. In patients of pulmonary tuberculosis drug induced hepatitis is common. However viral marker should be considered to rule out hepatitis B and hepatitis C. Close follow-up and regular liver test monitoring, viral marker is mandatory to treat TB in chronic hepatitis B and C carriers. DILI is a common problem among patients on ATT in our population. Early detection not only reduces the risk of developing Hepatic Failure but also prevents mortality rate.