Drug-induced liver disease 2004.
OBJECTIVE
To summarize the salient reviews, studies and case reports and series that dealt with clinical, pathological, methodological, and epidemiological descriptions of drug-induced liver disease in the calendar year 2004.


RESULTS
While no new causes of drug-induced liver injury were reported for 2004, several new reports of previously recognized hepatotoxins, including herbal products, were published. These include the antiretroviral drugs for HIV and agents to manage tuberculosis. Acetaminophen (APAP) retained its preeminent position as the leading cause of drug-induced acute liver failure, currently accounting for nearly 50% of cases according to the latest figures from the U.S. Acute Liver Failure Study Group. Not surprisingly, APAP also heads the list of drugs and toxins leading to liver transplantation for acute hepatic failure. Efforts to reduce the number of cases of intentional APAP poisonings by restricting the number of tablets sold at any one time in the UK are ongoing, but the success of the program may be lessening, as was pointed out this year. The use of potentially hepatotoxic medications in patients with underlying liver disease was examined with the statins, and they emerged as a safe class for use in this setting.


CONCLUSIONS
Given the apparent increasing incidence of acute liver failure attributable to APAP in the US, additional efforts are still needed to better define the risks associated with its use and to further reduce the incidence of severe liver injury from this widely used agent.
Lazerow
Susan K
SK
Division of Gastroenterology, Section of Hepatology, Georgetown University Medical Center, Washington, DC 20007, USA.
Abdi
Maaza S
MS
Lewis
James H
JH
D000082:Acetaminophen / Q000009:adverse effects; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects; D044966:Anti-Retroviral Agents / Q000009:adverse effects; D000995:Antitubercular Agents / Q000009:adverse effects; D056486:Chemical and Drug Induced Liver Injury; D019587:Dietary Supplements / Q000009:adverse effects; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects; D008107:Liver Diseases / Q000503:physiopathology; D008517:Phytotherapy / Q000009:adverse effects; D012307:Risk Factors; D045162:Thiazolidinediones / Q000009:adverse effects; D006113:United Kingdom
D018712:Analgesics, Non-Narcotic; D044966:Anti-Retroviral Agents; D000995:Antitubercular Agents; D013287:Illicit Drugs; D045162:Thiazolidinediones; D000082:Acetaminophen