Test for HCV First in Patients With Suspected Drug-Induced Liver Injury

Individuals with suspected drug-induced liver injury (DILI) should first undergo testing for hepatitis C virus (HCV) ribonucleic acid (RNA) to rule out potential HCV, according to a recent study.

DILI is typically diagnosed via liver injury tests, compatible history, and exclusion of other causes.

For the US DILI Network (DILIN) prospective study, the researchers evaluated 1734 patients with suspected DILI from any drug or herbal and dietary supplement from September 2004 to October 2016. All patients included in the study were enrolled within 6 months of liver injury onset and were further assessed at a 6-month follow-up visit. Patients with known HCV were also included.

Patients were tested for competing causes of liver injury. Consensus expert opinion determined causality with a 5-point scale, with a score of 1 indicating a definite liver injury, 2 indicating a highly likely injury, 3 indicating a probable injury, 4 indicating a possible injury, and 5 indicating that injury was unlikely.

Overall, 1518 patients had available HCV testing results, of which 1457 were for anti-HCV and 1482 were for HCV RNA. Of these patients, 104 had evidence of HCV infection, while 10 had HCV RNA only, 16 had anti-HCV only, and 78 had both.

The researchers noted that all cases had been suspected DILI at enrollment. However, at 6-month follow-up, 19 were found to be caused by HCV rather than DILI; only 4 were still considered DILI.

“Twenty-three of 1518 (1.5%) cases of suspected DILI were actually due to acute HCV infection,” the researchers concluded. “All patients presented with hepatocellular injury but were misdiagnosed usually due to lack of HCV RNA testing at the time of liver injury onset. These findings indicate that exclusion of acute HCV requires HCV RNA testing in patients with suspected DILI.”

—Christina Vogt

Reference:

Ahmad J, Reddy KR, Tillmann HL, et al. Testing for hepatitis C virus RNA is recommended in patients with suspected drug induced liver injury (DILI). Paper presented at: The AASLD Liver Meeting; October 20-24, 2017; Washington, DC. http://onlinelibrary.wiley.com/doi/10.1002/hep.29500/epdf.