Adverse drug reactions are responsible for increased costs and morbidity in the health system. Hepatotoxicity can be induced both by non-prescription drugs and by those used for chronic diseases. It is the main cause of safety-related drug marketing withdrawals and could be responsible for irreversible and fatal injuries.

To identify and to summarize Brazilian studies reporting the drug-induced liver injury.

A systematic review of Brazilian studies was carried out until June 2020. It was found 32 studies, being 10 retrospective cohorts, 12 prospective cohorts, 5 cross-sectional, 3 case-control, one case series and one randomized clinical trial. In most studies were investigated tuberculosis patients followed by other infectious conditions like human immunodeficiency virus (HIV) and hepatitis C virus. The hepatotoxicity ranged from one to 57%, led by isoniazid, rifampicin, and pyrazinamide. Few studies reported algorithm to assess causality. In most studies, there were moderate outcomes and it was necessary drug interruption. However, few severe outcomes, such as chronic liver damage and liver transplantation were reported.

Twenty-two different criteria for hepatotoxicity were found. The great heterogeneity did not allow a meta-analysis. Standardization of parameter of drug-induced liver injury and greater effort in pharmacovigilance could contribute to learn more about drug-induced liver injury (DILI)'s epidemiology in Brazil.

The development of strategic public health policies seems to have an influence on the DILI scientific evidence in Brazil due to main studies are in HIV and tuberculosis line care, two strategic health policies in Brazil.

Liver disease markers have been associated with mortality in HIV-infected individuals in the modern era of effective antiretroviral therapy. Our objective was to determine which markers are most predictive of mortality in HIV-monoinfected and HIV/hepatitis C virus (HCV)-coinfected persons.

We measured serum albumin, total protein, calculated globulin, aspartate transaminase (AST), and alanine transaminase in 193 HIV/HCV-coinfected and 720 HIV-monoinfected persons in the study of Fat Redistribution and Metabolic Change in HIV Infection. We evaluated associations of each marker with 5-year, all-cause mortality, adjusting for cardiovascular, HIV-related factors, inflammation, renal disease, muscle, and adiposity.

After 5 years of follow-up, overall mortality was 21% in HIV/HCV-coinfected and 12% in HIV-monoinfected participants. After multivariable adjustment, lower albumin and higher AST were independently associated with increased mortality. Lower albumin was associated with 49% increased odds of mortality overall [per 0.5 g/dl decrease, 95% confidence interval (CI): 1.2-1.9]; the association was stronger in HIV/HCV-coinfected [odds ratio (OR) = 2.1, 95% CI: 1.4-3.2] vs. HIV-monoinfected (OR = 1.3, 95% CI: 1.0-1.7; HCV-by-albumin interaction: P = 0.038). Higher AST was associated with 41% increased odds of mortality (per AST doubling; 95% CI: 1.1-1.8); associations were much stronger among HIV/HCV-coinfected (OR = 2.5, 95% CI: 1.5-4.1) than HIV-monoinfected (OR = 1.1, 95% CI: 0.8-1.5; HCV-by-AST interaction: P = 0.0042).

Lower serum albumin and higher AST appear to be important mortality risk factors in HIV/HCV-coinfection, but much less so in HIV-monoinfected individuals. The association of low albumin with mortality may reflect its role as a negative acute phase response protein. AST levels do not appear to be useful in predicting mortality in HIV-monoinfection and should be considered primarily in the context of HCV-coinfection.

- The increase in the survival following the introduction of highly active antiretroviral therapy (HAART) has seen the emergence of hepatitis C virus (HCV) infection, renal and cardiovascular diseases as important morbidity and mortality causes together with HIV.

- The present study aimed to investigate the differences between HIV/hepatitis C virus coinfected and HIV-monoinfected regarding demographic and clinical aspects from a HIV/AIDS clinic in Porto Alegre, Brazil.

- Review of medical records of 1,030 HIV infected individuals aged 18 years or more in an urban HIV/AIDS clinic based in Porto Alegre, Southern Brazil. Clinical and demographical Data were collected from the records of the patients attended between March 2008 and December 2012.

- The present study is a cross-sectional study among HIV-infected patients attended at a public HIV/AIDS clinic in Porto Alegre, Brazil. The prevalence of hepatitis C virus in the present study cohort was 11.8% (CI 95%: 9.9%-13.8%). Hypertension and pathological proteinuria were more common in the coinfected compared to monoinfected group. By the other hand, dyslipidemia were more common among monoinfected patients. There was no difference between the groups regarding CD4+ count or HIV-RNA. Variables significant in the univariate analysis with P<0.05 were further analyzed using a Poisson regression model with robust variance. Coinfected were likely to be older, with lower lipid levels and higher prevalence of pathological proteinuria compared to HIV-monoinfected patients. Although coinfected patients had higher prevalence of tenofovir-based regimen, there was a strong association between hepatitis C virus individuals to pathological proteinuria and dyslipidemia.

- Clinicians should recognize that coinfected and monoinfected individuals are different groups regarding the traditional and HIV-related risk factors and should be managed and screened individually in order to prevent cardiovascular and renal complications.