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Edelman EJ, Gordon KS, Lo Re V, Skanderson M, Fiellin DA, Justice AC, VACS Project Team. Acetaminophen receipt among HIV-infected patients with advanced hepatic fibrosis. Pharmacoepidemiology and drug safety. 2013 Dec 1; 22(12):1352-6.
PURPOSE: HIV-infected patients may be at particular risk for acetaminophen-induced hepatotoxicity, but acetaminophen use in the context of liver injury has been incompletely examined among HIV-infected patients. Among a sample of HIV-infected patients, we aimed to determine acetaminophen exposure, assess the cross-sectional association between acetaminophen exposure and advanced hepatic fibrosis, and determine whether factors associated with acetaminophen exposure varied by HCV status. METHODS: We conducted a cross-sectional analysis of the Veterans Aging Cohort Study. Advanced hepatic fibrosis was defined as a FIB-4? > 3.25, a composite score calculated based on age, alanine aminotransferase, aspartate aminotransferase, and platelet count. Multivariable ordered polytomous logistic regression was used to determine the association between FIB-4 status and acetaminophen exposure stratified by HCV status. RESULTS: Among HIV-infected patients (n? = 14?885), 31% received at least one acetaminophen prescription. Among those receiving acetaminophen, acetaminophen overuse was common among both HIV-monoinfected and HIV/HCV-coinfected patients (846 [31%] vs 596[32%], p? = 0.79). After stratifying by HCV status, those with evidence of advanced liver fibrosis were equally likely to be exposed to acetaminophen. Furthermore, HIV-monoinfected patients with an alcohol use disorder were more likely to have acetaminophen overuse (OR [95%CI]? = 1.56 [1.21-2.02]). CONCLUSIONS: Strategies to minimize acetaminophen exposure, especially for HIV-monoinfected patients, are warranted.