Drug-induced hepatitis is a common disease that affects patients taking certain type of medications. The presentation of these patients include jaundice, abdominal pain, nausea and vomiting.3 This case report will describe a middle aged gentleman with Acquired Immunodeficiency Syndrome (AIDS), Pulmonary Tuberculosis (PTB) and Hepatitis C who had just started on Highly Active AntiRetroviral Therapy (HAART) and had been rechallenged with antituberculosis drugs (anti-TB) who presented with signs of liver failure. This case highlights that there may be many factors that might cause the hepatotoxicity and we should know how to exclude which drug that might cause it and all other AIDS related complications.
Introduction
In patients with HIV, abnormal levels of liver enzymes are common and this might be due to multiple factors such as medication toxicity and coinfections with other liver disease. There are evidence that chronic viral hepatitis (hepatitis B or C) is associated with increased risk of antiretroviral-associated hepatotoxicity.7
As chronic viral hepatitis has a high prevalence in patients with HIV, clinicians should assess the risk of development of hepatotoxicity in these patients whenever HAART is initiated.7
Introduction of HAART has led to significant reductions in mortality and morbidity associated with HIV infection. However, even with the reduction in mortality and morbidity, there are still some adverse effects caused by these drugs. Hepatotoxicity is commonly seen in patients taking Non- Nucleoside Reverse Transcriptase Inhibitors (NNRTI), a drug used in HAART. Drug-induced liver injury is responsible for more than 50% of cases of acute liver injury in the United States. Furthermore, patients with concurrent Hepatit...
... middle of paper ...
... and micronodular cirrhosis were observed in the liver of a patient who died of rifampicin- and pyrazinamide-induced hepatotoxicity.4
Adverse drug reactions especially in the liver usually occurs in the 2 months of starting treatment but it can occur at any time during treatment period. Also, it is difficult to differentiate drug induced hepatitis from viral hepatitis particularly if a patient is co-infected with Hepatitis B or C.4.6
The signs and symptoms of liver injury that may be found are jaundice, abdominal pain, nausea, vomiting and asthenia. However, they are not specific enough to ascertain a liver disorder.4
Also, patient with anti-TB regimen who have co-infection with Hepatitis B, C and patients with HIV with HAART therapy and anti-TB regimen is at a higher risk of developing hepatotoxicity compared to patients receiving anti-TB with no liver disease.4,5
Quan, V. M., Go, V. F., Nam, L. V., Bergenstrom, A., Thuoc, N. P., Zenilman, J., ...Celentano, D.D. (2009). Risks for HIV, HBV, and HCV infections among male injection drug users in northern Vietnam: a case-control study. AIDS Care, 21(1), 7-16.
You look in the mirror and see that your skin and eyes seem a yellowish color, your legs and ankles are swollen, you have abdominal pain and swelling, your skin is also itchy, you have dark urine, and notice that your stool is a pale color. What do these symptoms mean? These are symptoms of damage to the liver. There are many ways to damage your liver like the use of alcohol, but a way you may not be aware of is the use of medication. Some medications when used repeatedly can cause liver damage, such as acetaminophen, also known as Tylenol.
HAV is known to be an infectious disease that usually occurs in children and young adults .The disease is usually transmitted from person to person through contaminated food, liquids or oral fecal route. An example would be when someone is carrying the virus and doesn’t wash their hands after using the restroom and then puts food in their mouth. HAV is most common in developing countries because of the living conditions and inadequate water, poor sewage facilities and sanitary conditions. The highest HAV levels in the world are from India,” Earlier reports suggest that India is hyperendemic for HAV infection2,4-6 with very high infection rates,” (Sowmyanarayanan). Most HAV are without severe complications, “Virus HAV infection rarely causes fulminant hepatic failure in people…,” (Vento,p.1) . The symptoms for HAV are high fever, nausea, vomiting and jaundice...
Hepatitis B is a DNA viral infection that causes damage and inflammation to the liver. It was first discovered in 1965 by Dr. Baruch Blumberg. The HBV virus is very contagious and is even thought to be the most serious form of viral hepatitis and the most common viral infection on Earth. “HBV is 100 times more infectious than HIV.” (Green, 2002, pg. 7) The virus can survive for about one week outside the body on a dry surface. According to Green (2002, pg. 7), “One in twenty Americans has been infected with the virus at some point in their lives.” Between the ages of 15-39 is when 75% of new HBV infections occur, according to Green (2002, pg.8).
Liver disease resulting from alcohol affects more than two million Americans and is one of the primary causes of illness and death. The liver frees the body of harmful substances, such as alcohol. While the liver breaks down alcohol, it produces toxins that can be even more dangerous than the alcohol consumed (“Beyond Hangovers: Understanding Alcohol's Impact on Your Health” 13). “These by-products damage liver cells, promote inflammation, and weaken the body’s natural defenses. Eventually, these problems can disrupt the body’s metabolism and impair the function of other organs” (“Beyond Hangovers: Understanding Alcohol’s Impact on Your Health” 13).
Autoimmune hepatitis is reported to become present after a person is infected with Hepatitis A. Autoimmune hepatitis occurs when the liver is attacked by the body’s immune system. Another complication associated with hepatitis A is relapsing hepatitis.
...blood and increase the absorption and concentration of digoxin in the blood. This may reduce the effectiveness of ketoconazole or increase digoxin toxicity. Through unknown mechanisms, omeprazole may increase blood levels of saquinavir and reduce blood levels of nelfinavir and atazanavir, drugs that are used for treating patients with infection caused by the human immunodeficiency virus (HIV). Omeprazole can be contraindicated in patient with hepatic impairment thus doctors are advised not to prescribe more than 20mg daily of omeprazole for such patients. [1] [3] [4]
The primary cause of hepatic cirrhosis in the United States is long-term alcoholism. Men respond differently than women to alcohol. With women one or two drinks a day can cause them liver damage. Men can consume two to five drinks a day and be ok. One drink a day can create liver scarring. So like everything else in life it varies, it might affect everyone differently. The individual who drinks alcohol on a daily basis, or more often then others have a higher risk of developing cirrhosis. Hepatic cirrhosis has also been linked to serious liver infections such as hepatitis B and hepatitis C. Patients who are HIV positive have died from developing cirrhosis through the hepatitis virus. Other causes of cirrhosis come from reactions to prescribed medications, injuries to the liver, exposure to toxic substances, and episodes of heart failure with liver congestion. Obt...
"The Nature of Hepatitis C Virus-Specific Cellular Immune Responses in HIV Co-Infected Individuals." NLM Gateway Search. Web. 30 Mar. 2010. .
This case study is about Abdul Chidiac, a 51 year old male, married with 4 children. He had a medical history of hypertension, hypercholesterolaemia and cirrhosis with two admissions in the last six months. He is a smoker and drinks beer, 5-6 bottles per day. As Carithers & McClain (2010) explained the patient’s medical history is another indicator of the risk for cirrhosis; the progression to cirrhosis is adaptable and may take time over weeks or many years. Cirrhosis is a liver disease characterized by permanent scarring of the liver that interferes with its normal functions including alcoholism. Most people who drink large amounts of alcohol cause harm to the liver in some way (Heidelbaugh & Bruderly, 2006). The cause of cirrhosis is not yet known, but the connection between cirrhosis and excessive alcohol ingestion is established (Jenkins & Johnson, 2010). Common causes of cirrhosis include: alcohol abuse, hepatitis B infection, hepatitis C infection and non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (Schuppan & Afdhal, 2008).
Although the sources of liver cancer are still unknown, there are some known risk factors. Viral infections of the liver, such as chronic Hepatitis B or C, may cause liver ca...
Hepatitis B (HBV) is a common disease in many parts of the world. It is a preventable disease through necessary immunization. However, there are currently millions of people who are still living with this disease worldwide. Chronic hepatitis B is considered to be a dangerous disease because it does not present any symptoms nor a person would feel sick. A blood test for liver enzymes may present within normal ranges that, by the time a person suffer from abdominal pain or the appearance of abdominal distension, any treatment usually becomes less effective. Two out of three Asian Americans with this disease does not know that they are infected. It is considered as one of the “silent killers” that if untreated, hepatitis B can lead to serious liver problems such as, cirrhosis and even liver cancer.
Zein, N. N., & Edwards, K. (2009). The Cleveland Clinic guide to liver disorders. New York: Kaplan Pub.
Acquired Immunodeficiency Syndrome (AIDS) first came to light in 1981. There has been a long and arduous global effort on the prevention of HIV/AIDS. HIV is a virus that is spread through body fluids that affect the specific T-cells of the immune system. Without treatment HIV infection leads to AIDS and there is no cure for AIDS. HIV infection can be controlled and the importance of primary pre...
In conclusion, liver is vascular organ of body and perform different function. Liver should be free from fats and injuries, different types of drugs are used in liver disease and still some research are going on different drugs and hormones but these researches were performed on limited number of patients because of different side effects and increased mortality rate. More researches and clinical guidelines should be performed on combination therapy of different drugs such as pentoxifylline, vitamin E, steroids and Ursodeoxycholic acid and this will help that how and in which way these drugs should be used in combination in order to prevent liver diseases. The government should provide funds for such types of research work in order to encourage them to eradicate different types of liver diseases.