Hepatotoxicity associated with antituberculosis therapy is an important clinical problem. Guidelines recommend baseline liver function tests (LFTs) before commencing treatment. In patients with risk factors for hepatotoxicity (ie, chronic viral hepatitis or liver disease, pregnancy or significant alcohol history) or abnormal baseline LFTs, further monitoring is indicated whilst on treatment.1 2 In all other cases repeat liver function testing is reserved for patients developing symptoms suggestive of liver dysfunction (fever, malaise, nausea, vomiting, abdominal pain, jaundice or unexplained fatigue). HIV co-infection is not specifically mentioned within UK guidance. Given increasing national rates of tuberculosis/HIV,3 we assessed how this might impact upon current guidelines.

A retrospective case-note review was undertaken of patients treated for active tuberculosis over a year (1 June 2006–31 May 2007) …