Tuberculosis Effects on the Liver

Liver Function Abnormalities in TB

TB infection can cause modest elevations of hepatic transaminases (ALT/AST) even before treatment begins, as reported by the Thorax journal 1, 2

Pre-existing liver disease increases the risk of hepatotoxicity during TB treatment, according to the Thorax journal 2, 3
HIV co-infection requires additional monitoring due to increased hepatotoxicity risk, as stated by the Clinical Infectious Diseases journal 4

Liver function tests (LFTs) should be performed before starting TB treatment, as recommended by the European Respiratory Journal 5, 6, 7
Regular monitoring of LFTs is required for patients with known chronic liver disease, as suggested by the Thorax journal 1, 2
Patients should be advised about symptoms of liver dysfunction and instructed to stop medication and seek medical attention if these occur, as advised by the Thorax journal 1, 2

If AST/ALT rises to five times the upper limit of normal or if bilirubin rises, hepatotoxic drugs should be stopped immediately, as recommended by the Thorax journal 2, 3
If the patient is not acutely ill and TB is non-infectious, treatment can be paused until liver function normalizes, as suggested by the Thorax journal 2, 3
For ill patients or those with infectious TB, alternative non-hepatotoxic drugs should be used until liver function normalizes, as recommended by the Thorax journal 2, 3

Alcohol consumption should be avoided during TB treatment due to increased hepatotoxicity risk, as advised by the European Respiratory Journal 5, 6

Isoniazid, rifampin, and pyrazinamide are predominantly metabolized by the liver and require careful monitoring in patients with liver disease, as reported by the European Respiratory Journal 7, 8
Streptomycin and ethambutol are less hepatotoxic and can be used as alternative agents when liver function is compromised, as suggested by the Thorax journal 2, 3