Side Effects of 9H Treatment for Latent TB: Liver Function Concerns - Pulmonology

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The treatment of latent tuberculosis (TB) with the 9H regimen, which typically includes isoniazid and rifampin, can lead to various side effects, particularly concerning liver function. In your case, the liver function tests (LFTs) show a significant increase in both AST (GOT) and ALT (GPT) levels, indicating potential liver injury.
1. Determining Hepatitis from Liver Function Tests:
The normal range for AST and ALT is generally considered to be up to 40 U/L, although this can vary slightly depending on the laboratory. Your initial values were within normal limits, but the follow-up values of AST at 56 U/L and ALT at 156 U/L suggest a degree of liver dysfunction. ALT is particularly sensitive to liver injury, and an ALT level above 100 U/L is often indicative of liver inflammation or hepatitis. Given your elevated ALT, it is reasonable to suspect that you may be experiencing drug-induced liver injury, which could be classified as hepatitis. However, the diagnosis of hepatitis would typically require additional clinical correlation, including symptoms (such as jaundice, nausea, or abdominal pain) and possibly imaging studies or a liver biopsy.

2. Should You Stop the Medication?:
Given the significant elevation in your liver enzymes, it is advisable to consider stopping the 9H treatment, especially if you are experiencing symptoms such as dizziness, loss of appetite, or abdominal pain. The general recommendation is to discontinue the medication if ALT exceeds 200 U/L or if there are concerning symptoms. In your case, since ALT is elevated but not above 200 U/L, the decision may depend on your overall clinical picture and the presence of symptoms. It is crucial to consult with your healthcare provider to evaluate the risks and benefits of continuing versus stopping the treatment.

3. Duration of Medication Interruption and Resuming Treatment:
If you do stop the medication, the duration of the interruption can vary. Typically, it is recommended to monitor liver function for at least a week after stopping the medication. If liver enzymes return to normal or near-normal levels, you may be able to resume treatment. However, it is essential to do this under medical supervision. The concern about developing drug resistance is valid; however, if the treatment is interrupted for a short period and then resumed, it is unlikely to lead to significant resistance, especially if the interruption is managed carefully.
In summary, your elevated liver enzymes are concerning and suggest possible drug-induced liver injury. It is essential to discuss these findings with your healthcare provider, who may recommend stopping the medication, monitoring liver function, and considering alternative treatment options if necessary. Regular follow-up and monitoring are critical in managing your treatment for latent TB while ensuring liver safety.