{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T12:55:17Z","timestamp":1793105717311,"version":"4.5.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2019,10,17]],"date-time":"2019-10-17T00:00:00Z","timestamp":1571270400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100009054","name":"U.S. President\u2019s Emergency Plan for AIDS Relief","doi-asserted-by":"publisher","award":["UM1AI069469"],"award-info":[{"award-number":["UM1AI069469"]}],"id":[{"id":"10.13039\/100009054","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Columbia University\u2013South Africa Fogarty AIDS International Training and Research Program","award":["D43 TW000231"],"award-info":[{"award-number":["D43 TW000231"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,6,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>New onset or worsening drug-induced liver injury challenges coinfected patients on antiretroviral therapy (ART) initiation during antituberculosis (TB) treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Post hoc analysis within a randomized trial, the Starting Antiretroviral Therapy at Three Points in Tuberculosis trial, was conducted. Patients were randomized to initiate ART either early or late during TB treatment or after TB treatment completion. Liver enzymes were measured at baseline, 6-month intervals, and when clinically indicated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 642 patients enrolled, the median age was 34 years (standard deviation, 28\u201340), and 17.6% had baseline CD4+ cell counts &amp;lt;50 cells\/mm3. Overall, 146\/472 patients (52, 47, and 47: early, late, and sequential arms) developed new-onset liver injury following TB treatment initiation. The incidence of liver injury post-ART initiation in patients with CD4+ cell counts &amp;lt;200 cells\/mm3 and \u2265200 cells\/ mm3 was 27.4 (95% confidence interval [CI], 18.0\u201339.8), 19.0 (95% CI, 10.9\u201330.9), and 18.4 (95% CI, 8.8\u201333.8) per 100 person-years, and 32.1 (95% CI, 20.1\u201348.5), 11.8 (95% CI, 4.3\u201325.7), and 28.2 (95% CI, 13.5\u201351.9) per 100 person-years in the early, late integrated, and sequential treatment arms, respectively. Severe and life-threatening liver injury occurred in 2, 7, and 3 early, late, and sequential treatment arm patients, respectively. Older age and hepatitis B positivity predicted liver injury.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>High incidence rates of liver injury among cotreated human immunodeficiency virus (HIV)\u2013TB coinfected patients were observed. Clinical guidelines and policies must provide guidance on frequency of liver function monitoring for HIV\u2013TB coinfected patients.<\/jats:p><\/jats:sec>","DOI":"10.1093\/cid\/ciz732","type":"journal-article","created":{"date-parts":[[2019,7,31]],"date-time":"2019-07-31T19:11:14Z","timestamp":1564600274000},"page":"2675-2682","source":"Crossref","is-referenced-by-count":27,"title":["High Rates of Drug-induced Liver Injury in People Living With HIV Coinfected With Tuberculosis (TB) Irrespective of Antiretroviral Therapy Timing During Antituberculosis Treatment: Results From the Starting Antiretroviral Therapy at Three Points in TB Trial"],"prefix":"10.1093","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8874-6661","authenticated-orcid":false,"given":"Kogieleum","family":"Naidoo","sequence":"first","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa"},{"name":"Medical Research Council, New York, New York-Centre for the AIDS Programme of Research in South Africa HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Razia","family":"Hassan-Moosa","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philile","family":"Mlotshwa","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nonhlanhla","family":"Yende-Zuma","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa"},{"name":"Medical Research Council, New York, New York-Centre for the AIDS Programme of Research in South Africa HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dhineshree","family":"Govender","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nesri","family":"Padayatchi","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa"},{"name":"Medical Research Council, New York, New York-Centre for the AIDS Programme of Research in South Africa HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salim S S","family":"Abdool-Karim","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa"},{"name":"Medical Research Council, New York, New York-Centre for the AIDS Programme of Research in South Africa HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa"},{"name":"Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,10,17]]},"reference":[{"key":"2021022210584496200_CIT0001","volume-title":"Global Tuberculosis report","author":"World Health Organization","year":"2018"},{"key":"2021022210584496200_CIT0002","doi-asserted-by":"crossref","first-page":"113","DOI":"10.4102\/sajhivmed.v14i3.63","article-title":"Consensus statement: management of drug-induced liver injury in HIV-positive patients treated for TB: guideline","volume":"14","author":"Jong","year":"2013","journal-title":"South Afr J HIV Med"},{"key":"2021022210584496200_CIT0003","first-page":"229","article-title":"Adverse effects of antiretroviral therapy for HIV infection","volume":"170","author":"Montessori","year":"2004","journal-title":"CMAJ"},{"key":"2021022210584496200_CIT0004","doi-asserted-by":"crossref","first-page":"1301","DOI":"10.1097\/QAD.0b013e32814e6b08","article-title":"Hepatotoxicity in an African antiretroviral therapy cohort: the effect of tuberculosis and hepatitis B","volume":"21","author":"Hoffmann","year":"2007","journal-title":"AIDS"},{"key":"2021022210584496200_CIT0005","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1056\/NEJM199503233321204","article-title":"Pulmonary tuberculosis in HIV-infected patients in Zaire. 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