Half of Abdominal TB Patients on ATT Develop Liver Abnormalities, Many Recover via Hepatic Adaptation: AIIMS Patna Study
India: A new prospective cohort study published in the Journal of Clinical and Experimental Hepatology has shed light on the patterns of liver injury and recovery in patients with abdominal tuberculosis (ATB) undergoing anti-tuberculosis treatment (ATT).
Conducted by Abhishek Kumar and colleagues from the Department of Gastroenterology, All India Institute of Medical Sciences (AIIMS), Patna, the research highlights how early monitoring and nutritional assessment can play a critical role in preventing severe drug-induced liver injury (DILI).
Patients with extra-pulmonary tuberculosis, including ATB, are known to have a higher risk of developing DILI during ATT. However, in some cases, liver function abnormalities resolve spontaneously through a process known as hepatic adaptation (HA). While previous studies have looked at DILI risk in pulmonary tuberculosis, prospective data specifically focusing on ATB patients have been scarce.
The study followed 140 patients with confirmed ATB and normal baseline liver function tests (LFTs). All participants received the standard four-drug ATT regimen, and their LFTs were monitored at regular intervals. Potential predictors of liver injury progression were assessed using multivariable logistic regression.
The study revealed the following notable findings:
- LFT abnormalities occurred in 71 patients (50.7%) during treatment.
- Twenty patients (14.2%) met the criteria for DILI at the first detection of abnormality.
- Of the remaining 51 patients, 18 (35.3%) progressed to DILI, while 33 (64.7%) showed spontaneous normalization of liver function, indicating hepatic adaptation.
- Overall, 27.1% of the study population developed DILI.
- Nearly half (46.4%) of those with LFT abnormalities recovered without requiring treatment interruption.
- Most DILI cases (89%) occurred within the first eight weeks of initiating ATT.
- The median time for hepatic adaptation was 21 days.
The analysis revealed that low serum albumin levels and vitamin D deficiency were independent predictors of progression from mild LFT abnormalities to DILI. These findings suggest that nutritional status may influence the liver’s ability to adapt during ATT.
When ATT was temporarily halted due to liver injury, complete reintroduction was successful in 65.8% of patients. Pyrazinamide was the drug most frequently linked to reintroduction failure. Importantly, none of the patients who developed DILI progressed to acute liver failure.
The authors note that while liver test abnormalities are common during ATT in ATB patients, nearly half can recover naturally due to hepatic adaptation. Identifying those at higher risk—particularly patients with hypoalbuminemia or vitamin D deficiency—could help clinicians prevent severe outcomes through closer monitoring and early intervention.
The study highlights the importance of regular LFT monitoring during the initial weeks of ATT, alongside nutritional assessment, to improve treatment safety and outcomes in abdominal TB patients.
Reference:
Kumar, A., Kumar, R., Kumar, V., Kumar, S., Marrapu, S., Anand, U., & Priyadarshi, R. N. (2025). Patterns of Liver Injury and Adaptation in Patients with Abdominal Tuberculosis on Antituberculosis Treatment: A Prospective Cohort Study. Journal of Clinical and Experimental Hepatology, 103124. https://doi.org/10.1016/j.jceh.2025.103124
