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Hassen G, Belete G, Carrera KG, Iriowen RO, Araya H, Alemu T, Solomon N, Bam DS, Nicola SM, Araya ME, Debele T, Zouetr M, Jain N. Clinical Implications of Herbal Supplements in Conventional Medical Practice: A US Perspective. Cureus 2022; 14:e26893. [PMID: 35978741 PMCID: PMC9375827 DOI: 10.7759/cureus.26893] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 11/05/2022] Open
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Potential Effects of Dietary Isoflavones on Drug-Induced Liver Injury. J FOOD QUALITY 2021. [DOI: 10.1155/2021/2870969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Numerous prescribed drugs and herbal and dietary supplements have been reported to cause drug-induced acute liver injury, which is a frequent cause of acute liver failure (ALF). It is a tremendous challenge with ever-increasing drug application in the medication system for huge populations. Drug-induced acute liver injury can lead to diverse pathologies similar to acute and chronic hepatitis, acute liver failure, biliary obstruction, fatty liver disease, and so on. Recently, extensive work demonstrated that isoflavones play an essential and protecting role in drug-induced liver injury (DILI). The isoflavones mediated hepatoprotection by modulating specific genes linked with control of cellular redox homeostasis and inflammatory responses. Isoflavones upregulate oxidative stress-responsive nuclear factor erythroid 2-like 2 (Nrf2), downregulate inflammatory nuclear factor-κB (NF-κB) signaling pathways, and modulate a balance between cell survival and death. Moreover, isoflavones actively inhibit the expression of cytochromes P450 (CYPs) enzyme during drug metabolism. Moreover, isoflavones are also linked with farnesoid X receptor (FXR) activation and signal transducer and activator of transcription factor 3 (STAT3) phosphorylation in hepatoprotection DILI. In vivo and in vitro studies clearly stated that isoflavones bear strong antioxidant potential and promising agents for hepatotoxicity prevention and stressed their potential role as therapeutic supplements in DILI. The current review will elaborate on isoflavones’ preventive and therapeutic potential concisely and highlight various molecular targets to exert a protective effect on DILI.
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Krstić MN, Mijač D, Tomašević RS, Lukić S, Stojković Lalošević M, Krstić JM, Milosavljević T. Abnormal Liver Blood Tests: Hepatologist Approach. Dig Dis 2021; 40:206-214. [PMID: 33971644 DOI: 10.1159/000517110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Available data suggest that the prevalence of chronic liver disease (CLD) and primary liver cancer is rising in Europe and represents a major public health problem. Predictions are showing that these trends will continue to rise in the upcoming years. SUMMARY Alcohol-related liver disease, nonalcohol fatty liver disease, and viral hepatitis B and hepatitis C are the leading causes of liver cirrhosis and primary liver cancer in Europe. Drug-induced liver injury represents a major cause of acute hepatitis, while liver transplantation is the second most common solid organ transplantation in the world. Patients with CLD have increasing rates of hospitalization, longer hospital stays, and more adverse outcomes compared to the other chronic conditions. Direct targeting of risk factors can prevent complications of advanced liver disease and improve outcome. Patients with CLD should be referred to a hepatologist for assessment of the stage of liver disease, for specific treatment and screening for hepatocellular carcinoma. Moreover, patients with unknown etiology of abnormal liver blood tests should be referred to a hepatologist for assessment of liver disease, as well as for prevention and treatment of complications of cirrhosis and/or portal hypertension. Key Messages: CLD is amenable to prevention and treatment, while disease management strategies need to improve in order to reduce the burden of liver disease and deaths due to end-stage liver diseases.
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Affiliation(s)
- Miodrag N Krstić
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Dragana Mijač
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Ratko S Tomašević
- Zemun Medical Center, Gastroenterology Department, Medical School, University of Belgrade, Belgrade, Serbia
| | - Snežana Lukić
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Milica Stojković Lalošević
- Clinic for Gastroenterology and Hepatology, University Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Jovan M Krstić
- Clinic for Digestive Surgery, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
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Weersink RA, Alvarez-Alvarez I, Medina-Cáliz I, Sanabria-Cabrera J, Robles-Díaz M, Ortega-Alonso A, García-Cortés M, Bonilla E, Niu H, Soriano G, Jimenez-Perez M, Hallal H, Blanco S, Kaplowitz N, Lucena MI, Andrade RJ. Clinical Characteristics and Outcome of Drug-Induced Liver Injury in the Older Patients: From the Young-Old to the Oldest-Old. Clin Pharmacol Ther 2021; 109:1147-1158. [PMID: 33179256 DOI: 10.1002/cpt.2108] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/02/2020] [Indexed: 02/05/2023]
Abstract
Older patients with hepatotoxicity have been scarcely studied in idiosyncratic drug-induced liver injury (DILI) cohorts. We sought the distinctive characteristics of DILI in older patients across age groups. A total of 882 DILI patients included in the Spanish DILI Registry (33% ≥ 65 years) were categorized according to age: "young" (< 65 years); "young-old" (65-74 years); "middle-old" (75-84 years); and "oldest-old" (≥ 85 years). All elderly groups had an increasingly higher comorbidity burden (P < 0.001) and polypharmacy (P < 0.001). There was a relationship between jaundice and hospitalization (P < 0.001), and both were more prevalent in the older age groups, especially in the oldest-old (88% and 69%, respectively), and the DILI episode was more severe (P = 0.029). The proportion of females decreased across age groups from the young to the middle-old, yet in the oldest-old there was a distinct female predominance. Pattern of liver injury shifted towards cholestatic with increasing age among top culprit drugs amoxicillin-clavulanate, atorvastatin, levofloxacin, ibuprofen, and ticlopidine. The best cutoff point for increased odds of cholestatic DILI was 65 years. Older patients had increased non-liver-related mortality (P = 0.030) as shown by the predictive capacity of the Model for End-Stage Liver Disease score (odds ratio (OR) = 1.116; P < 0.001), and comorbidity burden (OR = 4.188; P = 0.001) in the 6-month mortality. Older patients with DILI exhibited an increasingly predominant cholestatic phenotype across a range of culprit drugs, other than amoxicillin-clavulanate, with increased non-liver-related mortality and require a different approach to predict outcome. The oldest DILI patients exhibited a particular phenotype with more severe DILI episodes and need to be considered when stratifying older DILI populations.
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Affiliation(s)
- Rianne A Weersink
- Servicio de Farmacología Clínica, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga-IBIMA, Universidad de Málaga, Málaga, Spain
- Department of Clinical Pharmacy, Deventer Hospital, Deventer, The Netherlands
| | - Ismael Alvarez-Alvarez
- Servicio de Farmacología Clínica, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga-IBIMA, Universidad de Málaga, Málaga, Spain
| | - Inmaculada Medina-Cáliz
- Servicio de Farmacología Clínica, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga-IBIMA, Universidad de Málaga, Málaga, Spain
- Biomedical Research Network Center for Hepatic and Digestive Diseases (CIBERehd), Carlos III Health Institute, Madrid, Spain
| | - Judith Sanabria-Cabrera
- Servicio de Farmacología Clínica, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga-IBIMA, Universidad de Málaga, Málaga, Spain
- Platform for Clinical Research and Clinical Trials IBIMA, SCReN (Spanish Clinical Research Network), Madrid, Spain
| | - Mercedes Robles-Díaz
- Servicio de Farmacología Clínica, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga-IBIMA, Universidad de Málaga, Málaga, Spain
- Biomedical Research Network Center for Hepatic and Digestive Diseases (CIBERehd), Carlos III Health Institute, Madrid, Spain
| | - Aida Ortega-Alonso
- Biomedical Research Network Center for Hepatic and Digestive Diseases (CIBERehd), Carlos III Health Institute, Madrid, Spain
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga-IBIMA, Universidad de Málaga, Málaga, Spain
| | - Miren García-Cortés
- Biomedical Research Network Center for Hepatic and Digestive Diseases (CIBERehd), Carlos III Health Institute, Madrid, Spain
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga-IBIMA, Universidad de Málaga, Málaga, Spain
| | - Elvira Bonilla
- Servicio de Farmacología Clínica, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga-IBIMA, Universidad de Málaga, Málaga, Spain
| | - Hao Niu
- Servicio de Farmacología Clínica, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga-IBIMA, Universidad de Málaga, Málaga, Spain
| | - German Soriano
- Biomedical Research Network Center for Hepatic and Digestive Diseases (CIBERehd), Carlos III Health Institute, Madrid, Spain
- Servicio Aparato Digestivo, Hospital Santa Creu I Sant Pau, Barcelona, Spain
| | | | - Hacibe Hallal
- Servicio Aparato Digestivo, Hospital General Universitario J.M. Morales Meseguer, Murcia, Spain
| | - Sonia Blanco
- Servicio de Aparato Digestivo, Hospital Universitario Basurto, Bilbao, Spain
| | - Neil Kaplowitz
- Keck School of Medicine, University of Southern California Research Center for Liver Diseases, Los Angeles, California, USA
| | - M Isabel Lucena
- Servicio de Farmacología Clínica, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga-IBIMA, Universidad de Málaga, Málaga, Spain
- Biomedical Research Network Center for Hepatic and Digestive Diseases (CIBERehd), Carlos III Health Institute, Madrid, Spain
- Platform for Clinical Research and Clinical Trials IBIMA, SCReN (Spanish Clinical Research Network), Madrid, Spain
| | - Raúl J Andrade
- Biomedical Research Network Center for Hepatic and Digestive Diseases (CIBERehd), Carlos III Health Institute, Madrid, Spain
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de la Victoria, Instituto de Investigación Biomédica de Málaga-IBIMA, Universidad de Málaga, Málaga, Spain
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Abstract
Idiosyncratic (unpredictable) drug-induced liver injury is one of the most challenging liver disorders faced by hepatologists, because of the myriad of drugs used in clinical practice, available herbs and dietary supplements with hepatotoxic potential, the ability of the condition to present with a variety of clinical and pathological phenotypes and the current absence of specific biomarkers. This makes the diagnosis of drug-induced liver injury an uncertain process, requiring a high degree of awareness of the condition and the careful exclusion of alternative aetiologies of liver disease. Idiosyncratic hepatotoxicity can be severe, leading to a particularly serious variety of acute liver failure for which no effective therapy has yet been developed. These Clinical Practice Guidelines summarize the available evidence on risk factors, diagnosis, management and risk minimization strategies for drug-induced liver jury.
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Issa D, Wattacheril J, Sanyal AJ. Treatment options for nonalcoholic steatohepatitis - a safety evaluation. Expert Opin Drug Saf 2017. [PMID: 28641031 DOI: 10.1080/14740338.2017.1343299] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION There is an urgent as yet unmet need to develop highly effective and safe therapeutics for nonalcoholic fatty liver disease (NAFLD). The remarkable progress in understanding NAFLD pathogenesis allowed the identification of injury pathways which may be recruited as therapy targets. Areas covered: This article reviews the safety and tolerability data of the NAFLD therapies and explains the mechanistic basis for each of the established and investigational drugs. Treatment targets include: weight loss, anti-metabolic agents such as lipid lowering and anti-diabetic drugs, inflammation, fibrosis and others such as targeting gut microbiota, immune modulation and apoptosis. Expert opinion: Current therapies continue to remain suboptimal. Weight loss is effective but hard to achieve. Traditional and endoscopic bariatric procedures are promising although more randomized trials are needed and the long-term safety remains to be established. Clinical trials have demonstrated the efficacy of several drugs for the treatment of NASH. Of these, there remains some uncertainty about the long-term safety of vitamin E. Pioglitazone is associated with osteopenia, fluid retention and weight gain. Obeticholic acid causes pruritus in a substantial proportion of subjects and elafibranor has been associated with transient rises in creatinine. Several exciting therapies are under development and results of clinical and post-marketing trials will help elucidate their safety.
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Affiliation(s)
- Danny Issa
- a Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine , Virginia Commonwealth University School of Medicine , Richmond , VA , USA
| | - Julia Wattacheril
- b Center for Liver Disease and Transplantation and Division of Digestive and Liver Diseases, Department of Medicine , Columbia University College of Physicians and Surgeons , New York , NY , USA
| | - Arun J Sanyal
- a Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine , Virginia Commonwealth University School of Medicine , Richmond , VA , USA
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Tingting H, Yun Z, Jiabo W, Man G, Ruilin W, Ming N, Jing J, Lifu W, Zhongxia W, Ning Z, Zhaofang B, Yunfeng B, Yonggang L, Xiaohe X. Clinical characteristics of 96 patients with drug-induced acute liver failure: a comparison between Traditional Chinese and Western Medicine. J TRADIT CHIN MED 2017. [DOI: 10.1016/s0254-6272(17)30063-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Yu YC, Mao YM, Chen CW, Chen JJ, Chen J, Cong WM, Ding Y, Duan ZP, Fu QC, Guo XY, Hu P, Hu XQ, Jia JD, Lai RT, Li DL, Liu YX, Lu LG, Ma SW, Ma X, Nan YM, Ren H, Shen T, Wang H, Wang JY, Wang TL, Wang XJ, Wei L, Xie Q, Xie W, Yang CQ, Yang DL, Yu YY, Zeng MD, Zhang L, Zhao XY, Zhuang H. CSH guidelines for the diagnosis and treatment of drug-induced liver injury. Hepatol Int 2017; 11:221-241. [PMID: 28405790 PMCID: PMC5419998 DOI: 10.1007/s12072-017-9793-2] [Citation(s) in RCA: 182] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 03/14/2017] [Indexed: 02/07/2023]
Abstract
Drug-induced liver injury (DILI) is an important clinical problem, which has received more attention in recent decades. It can be induced by small chemical molecules, biological agents, traditional Chinese medicines (TCM), natural medicines (NM), health products (HP), and dietary supplements (DS). Idiosyncratic DILI is far more common than intrinsic DILI clinically and can be classified into hepatocellular injury, cholestatic injury, hepatocellular-cholestatic mixed injury, and vascular injury based on the types of injured target cells. The CSH guidelines summarized the epidemiology, pathogenesis, pathology, and clinical manifestation and gives 16 evidence-based recommendations on diagnosis, differential diagnosis, treatment, and prevention of DILI.
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Affiliation(s)
- Yue-Cheng Yu
- Liver Disease Center of PLA, Bayi Hospital, Nanjing University of Chinese Medicine, Nanjing, 210002, China
| | - Yi-Min Mao
- Department of Gastroenterology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, China.
| | - Cheng-Wei Chen
- Shanghai Liver Diseases Research Center, 85th Hospital, Nanjing Military Command, Shanghai, 200235, China.
| | - Jin-Jun Chen
- Hepatology Unit, Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jun Chen
- Liver Diseases Center, Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Wen-Ming Cong
- Department of Pathology, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 201805, China
| | - Yang Ding
- Department of Infectious Disease, Shengjing Hospital of China Medical University, Shenyang, 110004, China
| | - Zhong-Ping Duan
- Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China
| | - Qing-Chun Fu
- Shanghai Liver Diseases Research Center, 85th Hospital, Nanjing Military Command, Shanghai, 200235, China
| | - Xiao-Yan Guo
- Department of Gastroenterology, Second Affiliated Hospital, Xi'an Jiaotong University, Xian, 710004, China
| | - Peng Hu
- Department of Infectious Diseases, Institute for Viral Hepatitis, Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, China
| | - Xi-Qi Hu
- Department of Pathology, School of Medicine, Fudan University, Shanghai, 200433, China
| | - Ji-Dong Jia
- Liver Research Center, Beijing Friendship Hospital, Capital Medial University, Beijing, 100069, China
| | - Rong-Tao Lai
- Department of Infectious Diseases, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China
| | - Dong-Liang Li
- Department of Hepatobiliary Disease, Fuzhou General Hospital of PLA, Fuzhou, 350025, China
| | - Ying-Xia Liu
- Department of Liver Disease, Shenzhen Third People's Hospital, Shenzhen, 518040, China
| | - Lun-Gen Lu
- Department of Gastroenterology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200080, China
| | - Shi-Wu Ma
- Department of Infectious Diseases, Kunming General Hospital of PLA, Kunming, 650032, China
| | - Xiong Ma
- Department of Gastroenterology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, China
| | - Yue-Min Nan
- Department of Traditional and Western Medical Hepatology, Third Affiliated Hospital, Hebei Medical University, Shijiazhuang, 050051, China
| | - Hong Ren
- Department of Infectious Diseases, Institute for Viral Hepatitis, Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, China
| | - Tao Shen
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Beijing University, Beijing, 100083, China
| | - Hao Wang
- Institute of Hepatology, People's Hospital, Beijing University, Beijing, 100044, China
| | - Ji-Yao Wang
- Department of Gastroenterology, Zhongshan Hospital, School of Medicine, Fudan University, Shanghai, 200032, China
| | - Tai-Ling Wang
- Department of Pathology, China-Japan Friendship Hospital, Capital Medical University, Beijing, 100029, China
| | - Xiao-Jin Wang
- Shanghai Liver Diseases Research Center, 85th Hospital, Nanjing Military Command, Shanghai, 200235, China
| | - Lai Wei
- Institute of Hepatology, People's Hospital, Beijing University, Beijing, 100044, China
| | - Qing Xie
- Department of Infectious Diseases, Ruijin Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200025, China
| | - Wen Xie
- Center of Liver Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100011, China
| | - Chang-Qing Yang
- Department of Gastroenterology, Tongji Hospital, School of Medicine, Tongji University, Shanghai, 200065c, China
| | - Dong-Liang Yang
- Department of Infectious Disease, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yan-Yan Yu
- Department of Infectious Disease, Beijing University First Hospital, Beijing, 100034, China
| | - Min-de Zeng
- Department of Gastroenterology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, China
| | - Li Zhang
- Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, 100078c, China
| | - Xin-Yan Zhao
- Liver Research Center, Beijing Friendship Hospital, Capital Medial University, Beijing, 100069, China
| | - Hui Zhuang
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Beijing University, Beijing, 100083, China
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Sonderup MW, Wainwright H, Hall P, Hairwadzi H, Spearman CWN. A clinicopathological cohort study of liver pathology in 301 patients with human immunodeficiency virus/acquired immune deficiency syndrome. Hepatology 2015; 61:1721-9. [PMID: 25644940 DOI: 10.1002/hep.27710] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 01/13/2015] [Indexed: 01/09/2023]
Abstract
UNLABELLED Liver disease complicates human immunodeficiency virus (HIV)/acquired immune deficiency syndrome; however, liver pathology data are limited, particularly from high HIV prevalence countries. We investigated the spectrum and clinicopathological correlates of liver pathology in a high HIV burden setting. In a single-center study, all HIV/acquired immune deficiency syndrome patients with complete clinical and demographic data who underwent liver biopsy were analyzed and clinicopathologically assessed by hepatologists and one of two experienced liver pathologists. We evaluated 301 patients, with a median age of 34 (interquartile range 29-40) years. Women (n = 143) were younger than men (n = 158), with a median age of 33 (interquartile range 28-37) versus 35 (interquartile range 31-41) years, P = 0.001. The majority, 76.1%, were black African. Median CD4 at time of biopsy was 127 (52-260) cells/mm(3) . Drug-induced liver injury was the predominant finding (42.2%), followed by granulomatous inflammation (29%), steatosis/steatohepatitis (19.3%), hepatitis B (19%), and hepatitis C coinfection (3.3%), with more than one pathology in 16.2%. With granulomatous inflammation, 52% met the criteria for tuberculosis immune reconstitution syndrome. By univariate analysis, cotrimoxazole and antiretroviral therapy conferred risk for drug injury (odds ratio [OR] = 2.78 [1.72-4.48], P < 0.001; OR = 1.69 [1.06-2.68], P = 0.027). In multivariate analysis, cotrimoxazole was associated with a cholestatic or ductopenic injury (OR = 7.05 [2.50-19.89], P < 0.001; OR = 17.6 [3.26-95.3], P < 0.0001); efavirenz was associated with nonspecific hepatitis or submassive necrosis (OR = 4.3 [1.92-9.83], P < 0.001; OR = 10.46 [2.7-40.5], P < 0.001). Cholestatic injury was associated with female gender and a CD4 of >200 cells/mm(3) , and submassive necrosis was associated with younger age. Hepatitis B demonstrated no association. CONCLUSION In a high HIV burden area, drug-induced liver injury due to antiretroviral therapy and cotrimoxazole was a frequent clinicopathological finding; Mycobacterium tuberculosis was the leading opportunistic infection, with more than half of patients fulfilling criteria for tuberculosis immune reconstitution syndrome; liver biopsy remains a useful diagnostic procedure in this setting.
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Affiliation(s)
- Mark W Sonderup
- Division of Hepatology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
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Lewis JH. Drug-induced liver injury, dosage, and drug disposition: is idiosyncrasy really unpredictable? Clin Gastroenterol Hepatol 2014; 12:1556-61. [PMID: 24530601 DOI: 10.1016/j.cgh.2014.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 02/05/2014] [Accepted: 02/05/2014] [Indexed: 02/07/2023]
Affiliation(s)
- James H Lewis
- Department of Medicine, Division of Gastroenterology and Hepatology, Georgetown University Medical Center, Washington, DC
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11
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Chalhoub WM, Sliman KD, Arumuganathan M, Lewis JH. Drug-induced liver injury: what was new in 2013? Expert Opin Drug Metab Toxicol 2014; 10:959-80. [PMID: 24746272 DOI: 10.1517/17425255.2014.909408] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION The year 2013 continued to highlight numerous aspects of drug-induced liver injury (DILI), with new information communicated via > 1500 publications. New reports of DILI were described and FDA warnings and alerts were issued for a number of products, emphasizing the risks related to hepatotoxicity. AREAS COVERED We provide a summary of the year's published reports of new causes of DILI, along with reviews and reports of established hepatotoxins, new and expanded DILI registries and the continuing emphasis placed on genetic and other risk factors. Several new analyses of data generated from the US DILI Network are included. EXPERT OPINION The clinical usefulness of pharmacogenetic testing remains to be determined; the number of patients who must be tested is large and the overall risk of DILI is quite small. The role that dose and hepatic metabolism play in causing idiosyncratic DILI was reviewed; daily doses > 50 - 100 mg of medications with high lipophilicity appear to be most predictive of severe DILI, but not in all cases. Restricting access to paracetamol in certain parts of the UK continues to demonstrate a successful reduction in the number of acute liver failure cases and patients listed for liver transplant.
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Affiliation(s)
- Walid M Chalhoub
- Georgetown University Hospital, Department of Medicine, Division of Gastroenterology, Hepatology Section , 3800 Reservoir Road, NW, Washington, DC 20007 , USA
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