Prevalence and risk factors associated with rifampicin-induced cholestasis jaundice among tuberculosis patients in high-incidence setting: A retrospective cohort study

Background: Tuberculosis (TB) remains a global public health challenge, with Thailand identified as a high-burden country for TB and TB-HIV infections by WHO in 2021–2025. While the standard TB treatment regimen—including isoniazid, rifampicin, pyrazinamide, and ethambutol—is highly effective but drug-induced liver toxicity is a serious concern. Among these toxicities, cholestatic jaundice, primarily linked to rifampicin, is understudied in terms of its prevalence, risk factors, and clinical outcomes. Methods: A retrospective cohort study was conducted. The medical records of TB patients who received rifampicin between January 1, 2017, and November 30, 2022, were reviewed. Cases of cholestatic jaundice during treatment were identified. Demographic data, clinical characteristics, laboratory results, and treatment outcomes were collected and analyzed. Risk factors were assessed using univariate and multivariate logistic regressions. Results: The prevalence of rifampicin-induced cholestatic jaundice was 1.52%. Key risk factors were age ≥ 60 years (aOR: 3.82, 95% CI: 2.07–7.06, p < 0.001) and BMI < 18.5 kg/m2 (aOR: 2.94, 95% CI: 1.61–5.39, p < 0.001). To manage this side effect, rifampicin was discontinued in 74.5% cases while rifampicin was reintroduced in 43.9% cases. Overall, 61.1% of the patients achieved successful treatment after rifampicin was reintroduced. Conclusions: Rifampicin-induced cholestatic jaundice was observed in 1.52% of TB patients. Older age (≥60 years) and low BMI (<18.5 kg/m2) were identified as key risk factors.Early liver monitoring is essential in high-risk groups. Most patients tolerated rifampicin rechallenge, supporting individualized, risk-based management to ensure safe and effective TB treatment.