PATTERNS AND OUTCOMES OF DRUG-INDUCED LIVER INJURY IN HEPATITIS A: A PROSPECTIVE OBSERVATIONAL STUDY FROM A TERTIARY CARE CENTER IN NORTH INDIA.
Main Article Content
Keywords
Hepatitis A, Drug-induced liver injury, Complementary and alternative medicine, Cholestasis, acute liver failure, Steroids.
Abstract
Hepatitis A virus (HAV) infection is typically self-limiting, but atypical presentations and complications like drug-induced liver injury (DILI) can complicate its course. This study analyzes the pattern, frequency, and impact of DILI among patients with HAV and its role in the progression to severe liver outcomes.
Aims and Methods:
This prospective observational study was conducted over a one-year period at a tertiary care center in North India (Kashmir), including 105 patients aged 8–45 years diagnosed with HAV-related hepatitis. The study focused on clinical features, biochemical parameters, patterns of DILI, associated use of complementary and alternative medicine (CAM), response to corticosteroids, and severe outcomes such as acute liver failure (ALF), liver transplantation, and mortality. Statistical analysis was conducted using SPSS software; a p-value <0.05 was considered statistically significant.
Results:
Out of 105 patients, 5 (4.76%) developed DILI. All DILI cases had a history of CAM intake prior to admission. These patients presented with exaggerated cholestatic patterns (serum bilirubin >20 mg/dL in 60% of DILI cases) and markedly elevated liver enzymes (mean ALT: 2950 u/L). DILI was associated with a prolonged cholestatic course in 80% of cases and contributed to deterioration in 2 of the 3 ALF patients. Steroid therapy led to a favorable response in 100% of the 60 patients treated, including 4 of the 5 DILI patients. Among the ALF cases, one patient with suspected DILI-related exacerbation required liver transplantation, one responded to plasma exchange, and one died despite supportive care.
Conclusion:
DILI is an under-recognized but important contributor to atypical and severe courses of HAV infection. A detailed drug and CAM history is crucial in HAV patients. Early recognition and corticosteroid therapy may mitigate DILI-induced liver injury. Further multicentric studies are needed to understand the pathogenesis and management of DILI in viral hepatitis.
Aims and Methods:
This prospective observational study was conducted over a one-year period at a tertiary care center in North India (Kashmir), including 105 patients aged 8–45 years diagnosed with HAV-related hepatitis. The study focused on clinical features, biochemical parameters, patterns of DILI, associated use of complementary and alternative medicine (CAM), response to corticosteroids, and severe outcomes such as acute liver failure (ALF), liver transplantation, and mortality. Statistical analysis was conducted using SPSS software; a p-value <0.05 was considered statistically significant.
Results:
Out of 105 patients, 5 (4.76%) developed DILI. All DILI cases had a history of CAM intake prior to admission. These patients presented with exaggerated cholestatic patterns (serum bilirubin >20 mg/dL in 60% of DILI cases) and markedly elevated liver enzymes (mean ALT: 2950 u/L). DILI was associated with a prolonged cholestatic course in 80% of cases and contributed to deterioration in 2 of the 3 ALF patients. Steroid therapy led to a favorable response in 100% of the 60 patients treated, including 4 of the 5 DILI patients. Among the ALF cases, one patient with suspected DILI-related exacerbation required liver transplantation, one responded to plasma exchange, and one died despite supportive care.
Conclusion:
DILI is an under-recognized but important contributor to atypical and severe courses of HAV infection. A detailed drug and CAM history is crucial in HAV patients. Early recognition and corticosteroid therapy may mitigate DILI-induced liver injury. Further multicentric studies are needed to understand the pathogenesis and management of DILI in viral hepatitis.
References
1. Cyriac Abby Philips , Philip Augustine , Sasidharan Rajesh et al. Complementary and Alternative Medicine-related Drug-induced Liver Injury in Asia J Clin Transl Hepatol. 2019 Sep 28;7(3):263-274.
2. Desmond Chun Hwee Teo , Patricia Suet Leng Ng , Siew Har Tan et al. Drug-induced liver injury associated with Complementary and Alternative Medicine: a review of adverse event reports in an Asian community from 2009 to 2014. BMC Complement Altern Med. 2016 Jul 7:16:192
3. Luke Hillman , Michelle Gottfried , Maureen Whitsett , Jorge Rakela et al. Clinical Features and Outcomes of Complementary and Alternative Medicine Induced Acute Liver Failure and Injury. Am J Gastroenterol. 2016 Apr 5;111(7):958–965.
4. Navarro VJ, Khan I, Björnsson E, Seeff LB, Serrano J, Hoofnagle JH. Liver injury from herbal and dietary supplements. Hepatology. 2017;65(1):363–373.
5. Teschke R, Frenzel C, Schulze J, Eickhoff A. Herbal hepatotoxicity: challenges and pitfalls of causality assessment methods. World J Gastroenterol. 2013;19(19):2864–2882.
6. Chalasani NP, Maddur H, Russo MW, Wong RJ, Reddy KR. ACG Clinical Guideline: Diagnosis and Management of Idiosyncratic Drug-Induced Liver Injury. Am J Gastroenterol. 2021;116(5):878–898.
7. Philips CA, Paramaguru R, Joy AK, et al. Clinical outcomes, histopathology and HLA typing in drug-induced liver injury (DILI) due to antituberculosis treatment. Liver Int. 2018;38(10):1830–1838.
8. Björnsson ES. Drug‐induced liver injury: an overview over the most critical compounds. Arch Toxicol. 2015;89(3):327–334.
9. Lucena MI, Andrade RJ, Kaplowitz N, et al. Phenotypic characterization of idiosyncratic drug-induced liver injury: the influence of age and sex. Hepatology. 2009;49(6):2001–2009.
2. Desmond Chun Hwee Teo , Patricia Suet Leng Ng , Siew Har Tan et al. Drug-induced liver injury associated with Complementary and Alternative Medicine: a review of adverse event reports in an Asian community from 2009 to 2014. BMC Complement Altern Med. 2016 Jul 7:16:192
3. Luke Hillman , Michelle Gottfried , Maureen Whitsett , Jorge Rakela et al. Clinical Features and Outcomes of Complementary and Alternative Medicine Induced Acute Liver Failure and Injury. Am J Gastroenterol. 2016 Apr 5;111(7):958–965.
4. Navarro VJ, Khan I, Björnsson E, Seeff LB, Serrano J, Hoofnagle JH. Liver injury from herbal and dietary supplements. Hepatology. 2017;65(1):363–373.
5. Teschke R, Frenzel C, Schulze J, Eickhoff A. Herbal hepatotoxicity: challenges and pitfalls of causality assessment methods. World J Gastroenterol. 2013;19(19):2864–2882.
6. Chalasani NP, Maddur H, Russo MW, Wong RJ, Reddy KR. ACG Clinical Guideline: Diagnosis and Management of Idiosyncratic Drug-Induced Liver Injury. Am J Gastroenterol. 2021;116(5):878–898.
7. Philips CA, Paramaguru R, Joy AK, et al. Clinical outcomes, histopathology and HLA typing in drug-induced liver injury (DILI) due to antituberculosis treatment. Liver Int. 2018;38(10):1830–1838.
8. Björnsson ES. Drug‐induced liver injury: an overview over the most critical compounds. Arch Toxicol. 2015;89(3):327–334.
9. Lucena MI, Andrade RJ, Kaplowitz N, et al. Phenotypic characterization of idiosyncratic drug-induced liver injury: the influence of age and sex. Hepatology. 2009;49(6):2001–2009.
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Published
Nov 05, 2025
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How to Cite
Zeeshan Ahmad Wani, Rameez Raja Najar, Afrah Nasir, & Muzamil Majeed. (2025). PATTERNS AND OUTCOMES OF DRUG-INDUCED LIVER INJURY IN HEPATITIS A: A PROSPECTIVE OBSERVATIONAL STUDY FROM A TERTIARY CARE CENTER IN NORTH INDIA. Journal of Population Therapeutics and Clinical Pharmacology, 32(10), 107-110. https://doi.org/10.53555/0e292e08
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Author Biographies
Zeeshan Ahmad Wani
GMC Srinagar, Jammu and Kashmir UT, India 190010
Rameez Raja Najar
GMC Srinagar, Jammu and Kashmir UT, India 190010
Afrah Nasir
GMC Srinagar, Jammu and Kashmir UT, India 190010
Muzamil Majeed
GMC Srinagar, Jammu and Kashmir UT, India 190010
How to Cite
Zeeshan Ahmad Wani, Rameez Raja Najar, Afrah Nasir, & Muzamil Majeed. (2025). PATTERNS AND OUTCOMES OF DRUG-INDUCED LIVER INJURY IN HEPATITIS A: A PROSPECTIVE OBSERVATIONAL STUDY FROM A TERTIARY CARE CENTER IN NORTH INDIA. Journal of Population Therapeutics and Clinical Pharmacology, 32(10), 107-110. https://doi.org/10.53555/0e292e08