Liver Injury from Herbal and Dietary Supplements
A National Institutes of Health Workshop cosponsored by: AASLD, FDA, CDC, USDA
To evaluate the current status of use of herbal and dietary supplements (HDS) and the problem of their occasional hepatotoxicity. HDS are used commonly by the U.S. population and instances of acute liver injury in persons taking the products, although rare, are being increasingly reported. A similar rise in the frequency of reports of HDS-associated liver injury comes from Iceland, Europe, and Asia. The liver injury from HDS presents many clinical and research challenges. It is invariably unexpected and unpredictable, typically presenting in an acute viral hepatitis-like pattern, but without any serological markers of known hepatitis virus infections and with no evidence of other possible etiologies. The liver injury can be severe and lead to death from acute liver failure or the need for emergency liver transplantation. The attribution of the injury to a specific product is often difficult. Patients presenting with the acute liver injury often do not mention that they are taking HDS, or they may not know when they started or stopped the product, the dose, and sometimes even the name or nature of the HDS. The products themselves are often poorly labeled or mislabeled for their constituents and may have many components with little information on their concentration, source, or documentation of purity. This workshop is meant to bring together various federal, academic, and industry experts on HDS, biochemical analysis, hepatology, epidemiology, and surveillance of adverse events. The major aims of the symposium are to set a research agenda for better elucidation of the frequency, epidemiology, clinical features, outcomes, consequences, mechanisms, and means of treatment or prevention of liver injury associated with HDS. A summary of the workshop will be prepared for publication.