EFFECTIVENESS OF PLASMA EXCHANGE IN THE THERAPY OF DRUG-INDUCED HEPATITIS IN PATIENTS WITH PULMONARY TUBERCULOSIS AND CHRONIC VIRAL HEPATITIS B AND C.

BACKGROUND: This study evaluated the effectiveness of plasma exchange for the management of drug-induced hepatitis in patients with drug-resistant pulmonary tuberculosis, including those with concomitant chronic viral hepatitis. Along with standard conservative therapy, increasing attention is being paid to extracorporeal hemocorrection methods in the treatment of acute hepatitis. MATERIALS AND METHODS: The study included 127 patients with drug-resistant pulmonary tuberculosis treated at the City Center for Phthisiology and Internal Medicine in Astana from 2024 to February 2026. Chronic viral hepatitis was diagnosed in 65 of 127 patients: hepatitis B in 9 (13.8%), hepatitis C in 51 (78.5%), and mixed hepatitis B + C in 5 (7.7%). During anti-tuberculosis chemotherapy, 53 of 127 patients (41.7%) developed drug-induced hepatitis. This complication occurred significantly more often in patients with chronic viral hepatitis than in those without it: 39 of 65 (60.0%) versus 14 of 62 (22.6%), respectively (p < 0.001). Patients were divided into two groups, one of which received plasma exchange for the correction of drug-induced hepatitis. RESULTS: The use of plasma exchange in the study group made it possible to control manifestations of drug-induced hepatitis without discontinuing specific anti-tuberculosis therapy. In the control group, where plasma exchange was not used, temporary interruption of specific therapy was required. CONCLUSION: The inclusion of plasma exchange in the comprehensive treatment of drug-induced hepatitis in patients with drug-resistant pulmonary tuberculosis made it possible to control hepatotoxicity without interrupting anti-tuberculosis chemotherapy, which is especially important in patients with concomitant chronic viral hepatitis.