Background: Egypt has high Tuberculosis (TB), Hepatitis C (HCV) prevalence and intermediate Hepatitis B (HBV) prevalence with unclear Dug Induced liver injury (DILI) risk in chronic viral hepatitis patients.

Objective: To evaluate DILI incidence in tuberculous patients suffered from viral hepatitis co-infection compared to non hepatitis patients.

Methods: Newly diagnosed pulmonary TB patients under TB therapy were evaluated none invasively for DILI before and after treatment by liver function tests and liver fibrosis index (FIB-4 index).

Results: 195 tuberculous patients, age (19-61) years old. Of those, 62% (non hepatitis) were control, 31% HCV, 5% HBV, 2% were both (HB-C). Average baseline fibrosis indices in groups respectively were 0.81, 1.41, 0.70, and 1.47. Overall DILI respectively was 7%, 31%, 30%, 75%. FIB-4 index was significantly increased after treatment in all groups with significant difference between control and (HCV) group (p=0.04). The number of patients with FIB-4 index above 1.45 was 12%, 43%, 50%, 100% of all groups respectively with statistically significant difference in time lag to develop hepatotoxicity.

Conclusion: HCV, HBV, HB-C increases DILI risk after anti TB therapy. Meticulous follow up is advised. FBI-4 is a promising tool for liver damage evaluation. More studies are required to validate FIB-4 score.

Keywords: Tuberculosis; Drug induced liver injury; Liver fibrosis index