Abnormal Liver Function at the Time of Tuberculosis Diagnosis in South India

Background and objective: Assessing liver function before antituberculosis treatment (ATT) is not routinely recommended for all tuberculosis (TB) patients in India. This study aims to determine the proportion of adult drug-sensitive TB patients with abnormal liver function (ALF) at diagnosis and its associated factors. Materials and Methods: A cross-sectional study was conducted among adult TB patients notified from January 2021 to January 2023 at a tertiary care institute in Puducherry, India. Liver function tests and alcohol use assessments (using AUDIT-C) were performed. ALF was defined as aminotransferase levels more than thrice the upper normal limit (>150 mg/dL for males, >105 mg/dL for females) or total bilirubin more than twice the upper reference value (>2.0 mg/dL). Results: Of 1809 TB patients enrolled, 63% were males, and 14% were aged over 60 years. Microbiologically confirmed cases were 49%, and newly diagnosed cases were 89%. Alcohol use was reported by 33%, and 5% were HIV positive. ALF was present in 137 (7.5%; 95%CI: 6.3–8.7%) patients, and the proportion was higher in patients with hazardous alcohol use (11%), age >60 years (10%), HIV seropositivity (14%), and severe anemia (16%). Conclusion: One out of 13 TB patients had baseline ALF. Liver function tests may be recommended for selected high-risk patients before initiating ATT.