title: Acetaminophen receipt among HIV-infected patients with advanced hepatic fibrosis.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Medicine, Yale University, School of Medicine, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA.
authors.forename: E Jennifer
authors.initials: EJ
authors.lastname: Edelman
authors.forename: Kirsha S
authors.initials: KS
authors.lastname: Gordon
authors.forename: Vincent
authors.initials: V
authors.lastname: Lo Re
authors.forename: Melissa
authors.initials: M
authors.lastname: Skanderson
authors.forename: David A
authors.initials: DA
authors.lastname: Fiellin
authors.forename: Amy C
authors.initials: AC
authors.lastname: Justice
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage* / Q000009:adverse effects; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage* / Q000009:adverse effects; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D017723:Drug Utilization Review; D057286:Electronic Health Records; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D008103:Liver Cirrhosis / Q000139:chemically induced* / Q000453:epidemiology / Q000473:pathology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D014481:United States
chemical_list: D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen
keywords: HIV; Veterans; acetaminophen; hepatitis C; medication; pharmacoepidemiology