Objectives:

Hepatotoxicity is a common and potentially life-threatening complication in PLHIV, particularly in those on concurrent TB treatment. This session takes participants through the 2026 guideline approach to anti-tuberculosis drug-induced liver injury (AT-DILI): recognising and classifying DILI, differentiating it from TB-IRIS, deciding when and how to interrupt and sequentially re-challenge TB treatment and ART, and knowing when to escalate to specialist care.

Learning objectives:
By the end of the session, participants will be able to:
•    Identify the clinical and laboratory criteria for diagnosing AT-DILI (ALT and bilirubin thresholds, symptoms)
•    Classify DILI severity as mild, moderate or severe using symptoms and INR
•    Differentiate DILI from TB-IRIS on clinical and biochemical grounds
•    Apply the guideline’s stepwise approach to stopping, monitoring and re-challenging TB drugs, ART and prophylaxis in the correct order
•    Make appropriate ART decisions during DILI (continuing DTG, switching off EFV or LPV/r) and recognise when to refer for specialist management

Video

Speakers:

Ms Mathilda Ntloana
NDoH: CCMT Manager

Dr Lesego Mawela
HIV Clinician & Facilitator: Clinical Care Platform