A closer look at the spectrum of drug-induced liver injury in sub-Saharan Africa

ABSTRACT

Introduction: Drug-induced liver injury (DILI) has become the most frequent cause of acute liver failure in high-income countries. However, little is known about the determinants of DILI in sub-Saharan Africa (SSA), where the prescription of antimicrobials and the use of potentially hepatotoxic traditional medicine are common.

Areas covered: Based on an extensive literature search, we summarize current data available on the epidemiology and risk factors of DILI in SSA. We discuss the most likely causes of DILI in the region, including antimicrobial therapies and traditional medicine. We also highlight research gaps as well as barriers to diagnosis and management of the condition, and explore ways to address these important challenges.

Expert opinion: DILI is underestimated in SSA and several factors challenge its early diagnosis, including lack of information on the causes of DILI in the region, sub-optimal knowledge about the condition among clinicians, and structural difficulties faced by health care systems. In order to better prevent the occurrence of DILI and its complications, it is crucial to enhance awareness among health care providers and patients, adapt drug prescription habits and regulations, and improve current knowledge on the main risk factors for DILI, including host genetic and environmental determinants.

KEYWORDS:

• Drug-induced liver injury
• sub-Saharan Africa
• hepatotoxicity
• adverse drug reaction
• acute liver failure

Article highlights

• Drug-induced liver injury is a major cause of acute hepatitis and liver failure worldwide.

• DILI is rarely reported in SSA, even though potential hepatotoxic drugs are frequently used due to the high burden of infectious diseases in the region.

• The widespread use of traditional medicine and non-prescription drugs in the region makes it difficult to assess the spectrum of DILI and its consequences on the health of populations.

• Lack of awareness of health care providers and patients, as well as poor local capacity for diagnosis and monitoring, are major barriers to the prevention and management of DILI in SSA.

• Prospective cohort studies aiming at the collection and analysis of data from patients with DILI are urgently needed in SSA.

Declaration of interest

G Wandeler received research and travel grants from Gilead Sciences, MSD and AbbVie, not related to the submitted work. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

G Wandeler was supported by a Professorship Grant from the Swiss National Science Foundation (PP00P3_176944). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.