E E Bliven-Sizemore1, T R Sterling2, N Shang1, D Benator3, K Schwartzman4, R Reves5, J Drobeniuc6, N Bock1, M E Villarino1. 1. Division of Tuberculosis Elimination, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA. 2. Division of Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee, USA. 3. Division of Infectious Diseases, Veterans Affairs Medical Center, The George Washington University Medical Center, Washington DC, USA. 4. Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University, Montreal, Quebec, Canada. 5. Division of Infectious Disease, Department of Medicine, University of Colorado and Denver Health Hospital, Denver, Colorado, USA. 6. Division of Viral Hepatitis, CDC, Atlanta, Georgia, USA.
Abstract
SETTING: Nine months of daily isoniazid (9H) and 3 months of once-weekly rifapentine plus isoniazid (3HP) are recommended treatments for latent tuberculous infection (LTBI). The risk profile for 3HP and the contribution of hepatitis C virus (HCV) infection to hepatotoxicity are unclear. OBJECTIVES: To evaluate the hepatotoxicity risk associated with 3HP compared to 9H, and factors associated with hepatotoxicity. DESIGN: Hepatotoxicity was defined as aspartate aminotransferase (AST) >3 times the upper limit of normal (ULN) with symptoms (nausea, vomiting, jaundice, or fatigue), or AST >5 x ULN. We analyzed risk factors among adults who took at least 1 dose of their assigned treatment. A nested case-control study assessed the role of HCV. RESULTS: Of 6862 participants, 77 (1.1%) developed hepatotoxicity; 52 (0.8%) were symptomatic; 1.8% (61/3317) were on 9H and 0.4% (15/3545) were on 3HP (P < 0.0001). Risk factors for hepatotoxicity were age, female sex, white race, non-Hispanic ethnicity, decreased body mass index, elevated baseline AST, and 9H. In the case-control study, HCV infection was associated with hepatotoxicity when controlling for other factors. CONCLUSION: The risk of hepatotoxicity during LTBI treatment with 3HP was lower than the risk with 9H. HCV and elevated baseline AST were risk factors for hepatotoxicity. For persons with these risk factors, 3HP may be preferred.
SETTING: Nine months of daily isoniazid (9H) and 3 months of once-weekly rifapentine plus isoniazid (3HP) are recommended treatments for latent tuberculous infection (LTBI). The risk profile for 3HP and the contribution of hepatitis C virus (HCV) infection to hepatotoxicity are unclear. OBJECTIVES: To evaluate the hepatotoxicity risk associated with 3HP compared to 9H, and factors associated with hepatotoxicity. DESIGN:Hepatotoxicity was defined as aspartate aminotransferase (AST) >3 times the upper limit of normal (ULN) with symptoms (nausea, vomiting, jaundice, or fatigue), or AST >5 x ULN. We analyzed risk factors among adults who took at least 1 dose of their assigned treatment. A nested case-control study assessed the role of HCV. RESULTS: Of 6862 participants, 77 (1.1%) developed hepatotoxicity; 52 (0.8%) were symptomatic; 1.8% (61/3317) were on 9H and 0.4% (15/3545) were on 3HP (P < 0.0001). Risk factors for hepatotoxicity were age, female sex, white race, non-Hispanic ethnicity, decreased body mass index, elevated baseline AST, and 9H. In the case-control study, HCV infection was associated with hepatotoxicity when controlling for other factors. CONCLUSION: The risk of hepatotoxicity during LTBI treatment with 3HP was lower than the risk with 9H. HCV and elevated baseline AST were risk factors for hepatotoxicity. For persons with these risk factors, 3HP may be preferred.
Authors: P Sadaphal; J Astemborski; N M Graham; L Sheely; M Bonds; A Madison; D Vlahov; D L Thomas; T R Sterling Journal: Clin Infect Dis Date: 2001-10-12 Impact factor: 9.079
Authors: Neil A Martinson; Grace L Barnes; Lawrence H Moulton; Reginah Msandiwa; Harry Hausler; Malathi Ram; James A McIntyre; Glenda E Gray; Richard E Chaisson Journal: N Engl J Med Date: 2011-07-07 Impact factor: 91.245
Authors: Jussi J Saukkonen; David L Cohn; Robert M Jasmer; Steven Schenker; John A Jereb; Charles M Nolan; Charles A Peloquin; Fred M Gordin; David Nunes; Dorothy B Strader; John Bernardo; Raman Venkataramanan; Timothy R Sterling Journal: Am J Respir Crit Care Med Date: 2006-10-15 Impact factor: 21.405
Authors: Timothy R Sterling; James Bethel; Stefan Goldberg; Paul Weinfurter; Lourdes Yun; C Robert Horsburgh Journal: Am J Respir Crit Care Med Date: 2006-01-19 Impact factor: 21.405
Authors: Lauren A Lambert; Lori R Armstrong; Mark N Lobato; Christine Ho; Anne Marie France; Maryam B Haddad Journal: Am J Public Health Date: 2016-09-15 Impact factor: 9.308
Authors: J Morgan Freiman; Karen R Jacobson; Winnie R Muyindike; C Robert Horsburgh; Jerrold J Ellner; Judith A Hahn; Benjamin P Linas Journal: J Acquir Immune Defic Syndr Date: 2018-04-01 Impact factor: 3.731
Authors: Kristine M Schmit; Mark N Lobato; Simona G Lang; Sherri Wheeler; Newton E Kendig; Sarah Bur Journal: J Public Health Manag Pract Date: 2019 Mar/Apr
Authors: Godwin Mindra; Jonathan M Wortham; Maryam B Haddad; Jorge L Salinas; Krista M Powell; Lori R Armstrong Journal: J Immigr Minor Health Date: 2017-08
Authors: Gibril J Njie; Sapna Bamrah Morris; Rachel Yelk Woodruff; Ruth N Moro; Andrew A Vernon; Andrey S Borisov Journal: Am J Prev Med Date: 2018-06-14 Impact factor: 5.043