แพ้ยาวัณโรค ต่อ ผิวหนัง แบบธรรมดา และ แบบรุนแรง

liver

Tostmann A, Boeree MJ, Aarnoutse RE, de Lange WC, van der Ven AJ, Dekhuijzen R.Antituberculosis drug-induced hepatotoxicity: Concise up-to-date review

 J Gastroenterol Hepatol. 2008 Feb;23(2):192-202.

 The reported incidence of antituberculosis drug-induced hepatotoxicity, the most serious and potentially fatal adverse reaction, varies between 2% and 28%. Risk factors are advanced age, female sex, slow acetylator status, malnutrition, HIV and pre-existent liver disease. Still, it is difficult to predict what patient will develop hepatotoxicity during tuberculosis treatment.

 

 

 

 

The incidence of the reactions was significantly higher in HIV seropositive (23.1%) than

HIV seronegative patients (1.0%) (p < 0.001).

Two HIV seropositive patients who developed Steven-Jonson syndrome died. The drugs incriminated for adverse skin reactions in the nine patients who survived were pyrazinamide (four cases) and rifampicin (five cases). CONCLUSION: HIV infected patients on antituberculosis drug should be monitored for adverse skin reactions which are sometimes fatal.

 

Kuaban C, Bercion R, Koula-Shiro S.Current HIV seroprevalence rate and incidence of adverse skin reactions in adults with pulmonary tuberculosis receiving thiacetazone-free antituberculosis treatment in Yaounde, Cameroon. Cent Afr J Med. 1998 Feb;44(2):34-7

Int J STD AIDS 2009;20:339-345
doi:10.1258/ijsa.2008.008361
© 2009 Royal Society of Medicine Press

D J B Marks , K Dheda  , R Dawson , G Ainslie   and R F Miller 
Adverse events to antituberculosis therapy: influence of HIV and antiretroviral drugs

This study investigated whether serious adverse events (SAEs) during antituberculosis therapy occur more frequently in HIV co-infected patients in a South African population. A retrospective analysis examined incidences of hepatotoxicity, peripheral neuropathy, severe arthralgia, persistent vomiting and severe rash in 400 patients treated for tuberculosis in a community clinic. A total of 141 patients were co-infected with HIV, among whom only 16.3% were receiving antiretrovirals.

 Details of SAEs were ascertainable in 331/400 patients, and

occurred in 26.7% of HIV-infected and

 13.3% of HIV-uninfected individuals (P = 0.003).

The excess was attributable to increased peripheral neuropathy (8.3% and 1.9%, respectively, P = 0.009) and

persistent vomiting (13.3% and 3.3%, P = 0.001).

SAE occurrence was not related to antiretroviral use, although median CD4 counts were lower in those experiencing side-effects (130 and 259 cells/µL, P = 0.008).

 The treatment completion did not differ significantly between the two groups (76.6% and 84.2%, P = 0.08