Incidence, risk factors, and outcomes of anti-tuberculosis drug-induced hepatotoxicity in people with and without HIV in Thailand and the Philippines

Characteristic	TB (n = 84)	TB-HIV (n = 138)	Total (N = 222)	P
Age (years), median (IQR)	40 (28–47)	37.3 (30.2–46.4)	38.2 (29–47)	0.997
BMI (kg/m²), median (IQR)	18.2 (17.8–18.6)	19.9 (19.4–20.5)	18.2 (17.8–18.6)	0.37
Sex				0.15
Female	36 (42.9)	46 (33.3)	82 (36.9)
Male	48 (57.1)	92 (66.7)	140 (63.1)
Type of TB**
Pulmonary	71 (84.5)	105 (76.1)	176 (79.3)	0.17
Extrapulmonary	18 (21.4)	35 (25.4)	53 (23.9)	0.63
Prior TB diagnosis	4 (4.8)	15 (10.9)	19 (8.6)	0.14
Bacteriological confirmation**
Sputum smear	2 (2.4)	18 (13.0)	20 (9.0)	-
Culture of M. tub.	31 (36.9)	20 (14.5)	51 (23.0)	-
Molecular testing (Gene Xpert)	48 (57.1)	81 (58.7)	129 (58.1)	-
Alcohol use	16 (19.0)	26 (18.8)	42 (18.9)	0.97
Illicit drug use	0 (0.0)	6 (4.3)	6 (2.7)	0.05
Comorbidities
HBV co-infection	2 (2.4)	12 (8.7)	14 (6.3)	0.06
HCV co-infection	0 (0.0)	13 (9.4)	13 (5.9)	0.004
Diabetes mellitus	18 (21.7)	7 (5.1)	25 (11.3)	<0.001
Chronic kidney disease	2 (2.4)	1 (0.7)	3 (1.4)	0.30
Concomitant medications
Fluconazole use	0 (0.0)	27 (19.6)	27 (12.2)	<0.001
Cotrimoxazole use	1 (1.2)	33 (23.9)	34 (15.3)	<0.001
Both (Cotrimoxazole + Fluconazole)	0 (0.0)	20 (14.5)	20 (9.0)	<0.001
NAT2 Genotype***
Slow acetylator	-	38 (43.7)	38 (43.7)	-
Intermediate acetylator	-	25 (28.7)	25 (28.7)	-
Rapid acetylator	-	24 (27.6)	24 (27.6)	-
ART regimen
Efavirenz	-	79 (57.2)	79 (57.2)	-
Dolutegravir	-	59 (42.8)	59 (42.8)	-
CD4 category (cells/mm³)
>500	-	15 (10.9)	15 (10.9)	-
200–500	-	47 (34.1)	47 (34.1)	-
<200	-	76 (55.1)	76 (34.2)	-

Demographic characteristics by study site (Thai vs Filipino)

Characteristic	Thai (n = 174)	Filipino (n = 48)	Total (N = 222)	P
Age (years), median (IQR)	40 (37–43)	32.5 (28–37)	38.2 (29–47)	<0.001
BMI (kg/m²), median (IQR)	20.1 (19.6–20.7)	19.4 (18.2–21.5)	18.2 (17.8–18.6)	0.29
Sex				0.56
Female	66 (37.9)	16 (33.3)	82 (36.9)
Male	108 (62.1)	32 (66.7)	140 (63.1)	-
Type of TB**				<0.001
Pulmonary	128 (73.6)	48 (100.0)	176 (79.3)	-
Extrapulmonary	53 (30.5)	0 (0.0)	53 (23.9)	-
Prior TB diagnosis	16 (9.2)	3 (6.2)	19 (8.6)	0.52
Bacteriological confirmation**				0.02
Sputum Smear	20 (11.5)	0 (0.0)	20 (9.0)	-
Culture of M. tub.	44 (25.3)	7 (14.6)	51 (23.0)	-
Molecular Testing (Gene Xpert)	94 (54.0)	35 (72.9)	129 (58.1)	-
Alcohol use	26 (14.9)	16 (33.3)	42 (18.9)	0.004
Illicit drug use	6 (3.4)	0 (0.0)	6 (2.7)	0.19
Comorbidities
HBV co-infection	14 (8.0)	0 (0.0)	14 (6.3)	0.05
HCV co-infection	13 (7.5)	0 (0.0)	13 (5.9)	0.05
Diabetes mellitus	14 (8.0)	11 (23.4)	25 (11.3)	0.003
Chronic kidney disease	3 (1.7)	0 (0.0)	3 (1.4)	0.36
Concomitant medications
Fluconazole use	26 (14.9)	1 (2.1)	27 (12.2)	0.02
Cotrimoxazole use	28 (16.1)	6 (12.5)	34 (15.3)	0.51
Cotrimoxazole + Fluconazole	20 (11.5)	0 (0.0)	20 (9.0)	0.02

Incidence of DIH in TB-HIV groups vs TB group

	TB n (%)	TB-HIV n (%)	Total N (%)
No DIH	76 (90.48)	119 (86.23)	195 (87.84)
DIH	8 (9.52)	19 (13.77)	27 (12.16)

Risk factors for DIH during TB treatment

	Univariable		Multivariable

	Odds ratio (95% CI)	P	Adjusted odds ratio (95% CI)	P
TB-HIV and TB groups
TB-HIV co-infection vs TB mono-infection	1.62 (0.68–3.91)	0.28
Age (per year increase)	1.03 (1.00–1.07)	0.05	1.04 (1.01–1.08)	0.02
BMI (kg/m²)	0.81 (0.70–0.95)	0.01	0.77 (0.65–0.92)	0.003
Male vs female	0.83 (0.37–1.89)	0.66
Type of TB
Pulmonary	1.58 (0.52–4.82)	0.42
Extrapulmonary	0.52 (0.17–1.57)	0.25
Prior TB diagnosis	0.84 (0.18–3.84)	0.82
Alcohol use vs no alcohol use	0.97 (0.34–2.73)	0.95
Illicit drug use vs no drug use	1.46 (0.16–13.00)	0.73
HBV co-infection	1.21 (0.26–5.74)	0.81
HCV co-infection	5.28 (1.59–17.57)	0.01	6.13 (1.60–23.45)	0.01
Diabetes mellitus	0.59 (0.13–2.68)	0.5
Fluconazole use	1.3 (0.41–4.10)	0.65
Cotrimoxazole use	1.3 (0.46–3.71)	0.62
TB-HIV group only
Age (per year increase)	1.01 (0.97–1.06)	0.52
BMI (kg/m²)	0.8 (0.65–0.97)	0.02	0.78 (0.63–0.97)	0.03
Male vs female	1.22 (0.43–3.46)	0.71
Type of TB		0.31
Pulmonary	1.98 (0.54–7.26)	0.31
Extrapulmonary	0.46 (0.12–1.69)	0.25
Prior TB diagnosis	0.89 (0.18–4.29)	0.88
ART regimen		0.20
Efavirenz—NNRTI	1 (ref)
Dolutegravir—INSTI	0.51 (0.18–1.42)
CD4 category (cells/mm³)		0.39
>500	1 (ref)
200–500	3.41 (0.39–29.40)
<200	2.10 (0.25–17.96)
Alcohol use vs no alcohol use	1.29 (0.39–4.32)	0.68
Illicit drug use vs no drug use	1.18 (0.13–10.68)	0.88
HBV co-infection	1.19 (0.24–5.90)	0.83
HCV co-infection	4.6 (1.32–16.03)	0.02	5.84 (1.51–22.55)	0.01
Diabetes mellitus	0.97 (0.11–8.56)	0.98
Fluconazole use	1.08 (0.33–3.57)	0.90
Cotrimoxazole use	0.97 (0.29–3.18)	0.96

Tuberculosis treatment outcomes between groups

Treatment outcome	TB	TB-HIV	P*	No DIH	DIH	P*

	n (%)	n (%)		n (%)	n (%)
Died	1 (1.2)	3 (2.2)	0.49	3 (1.5)	1 (3.7)	0.81
Lost to follow-up	0 (0.0)	1 (0.7)		1 (0.5)	0 (0.0)
Not evaluated	2 (2.4)	10 (7.2)		11 (5.6)	1 (3.7)
Treatment failed	1 (1.2)	3 (2.2)		4 (2.1)	0 (0.0)
Treatment success	80 (95.2)	121 (87.7)		176 (90.3)	25 (92.6)

References

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Articles in this issue

DOI: https://doi.org/10.2478/abm-2026-0020 | Journal eISSN: 1875-855X | Journal ISSN: 1905-7415

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Language: English

Page range: 170 - 181

Published on: Jun 30, 2026

Published by: Chulalongkorn University

In partnership with: Paradigm Publishing Services

Keywords:

anti-tuberculosis therapy,

drug-induced hepatotoxicity,

HIV,

TB-HIV,

tuberculosis treatment

Related subjects:

Medicine,

Clinical medicine,

Clinical medicine, other,

Medicine,

Basic medical science,

Basic medical science, other,

Medicine,

Assistive professions, nursing

© 2026 Ryan Christopher Geturbos Atuel, Emmanuel A. Gutierrez, Napon Hiranburana, Tanakorn Apornpong, Sasiwimol Ubolyam, Ma. Tarcela S. Gler, Anchalee Avihingsanon, Sivaporn Gatechompol, Stephen J. Kerr, published by Chulalongkorn University
This work is licensed under the Creative Commons Attribution 4.0 License.

Volume 20 (2026): Issue 3 (June 2026)

Incidence, risk factors, and outcomes of anti-tuberculosis drug-induced hepatotoxicity in people with and without HIV in Thailand and the Philippines

Figures & Tables

Figure 1.

Demographic characteristics

Demographic characteristics by study site (Thai vs Filipino)

Incidence of DIH in TB-HIV groups vs TB group

Risk factors for DIH during TB treatment

Tuberculosis treatment outcomes between groups

Paradigm

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