{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T09:10:43Z","timestamp":1791882643982,"version":"4.3.4"},"reference-count":40,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2017,1,28]],"date-time":"2017-01-28T00:00:00Z","timestamp":1485561600000},"content-version":"vor","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R01 HS018372"],"award-info":[{"award-number":["R01 HS018372"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["F32 AI120363"],"award-info":[{"award-number":["F32 AI120363"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K24 DK078228"],"award-info":[{"award-number":["K24 DK078228"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000027","name":"National Institute on Alcohol Abuse and Alcoholism","doi-asserted-by":"publisher","award":["U01 AA13566"],"award-info":[{"award-number":["U01 AA13566"]}],"id":[{"id":"10.13039\/100000027","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000027","name":"National Institute on Alcohol Abuse and Alcoholism","doi-asserted-by":"publisher","award":["U24 AA20794"],"award-info":[{"award-number":["U24 AA20794"]}],"id":[{"id":"10.13039\/100000027","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000027","name":"National Institute on Alcohol Abuse and Alcoholism","doi-asserted-by":"publisher","award":["U01 AA20790"],"award-info":[{"award-number":["U01 AA20790"]}],"id":[{"id":"10.13039\/100000027","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The risk of hepatotoxicity with antiretroviral therapy (ART) remains unknown. We determined the comparative risk of acute liver injury (ALI) for antiretroviral drugs, classes, and regimens, by viral hepatitis status.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We followed a cohort of 10 083 human immunodeficiency virus (HIV)-infected persons in Kaiser Permanente Northern California (n = 2099) from 2004 to 2010 and the Veterans Aging Cohort Study (n = 7984) from 2004 to 2012. Within the first year of ART, we determined occurrence of (1) liver aminotransferases &amp;gt;200 U\/L and (2) severe ALI (coagulopathy with hyperbilirubinemia). We used Cox regression to determine hazard ratios (HRs) with 95% confidence intervals (CIs) of endpoints among initiators of nucleos(t)ide analogue combinations, antiretroviral classes, and ART regimens, all stratified by viral hepatitis status.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Liver aminotransferases &amp;gt;200 U\/L developed in 206 (2%) persons and occurred more frequently among HIV\/viral hepatitis-coinfected than HIV-monoinfected persons (116.1 vs 20.7 events\/1000 person-years; P &amp;lt; .001). No evidence of differential risk was found between initiators of abacavir\/lamivudine versus tenofovir\/emtricitabine among coinfected (HR, 0.68; 95% CI, .29\u20131.57) or HIV-monoinfected (HR, 1.19; 95% CI, .47\u20132.97) groups. Coinfected patients had a higher risk of aminotransferases &amp;gt;200 U\/L after initiation with a protease inhibitor than nonnucleoside reverse-transcriptase inhibitor (HR, 2.01; 95% CI, 1.36\u20132.96). Severe ALI (30 events; 0.3%) occurred more frequently in coinfected persons (15.9 vs 3.1 events\/1000 person-years; P &amp;lt; .001) but was too uncommon to evaluate in adjusted analyses.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Within the year after ART initiation, aminotransferase elevations were infrequently observed and rarely led to severe ALI. Protease inhibitor use was associated with a higher risk of aminotransferase elevations among viral hepatitis-coinfected patients.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofx012","type":"journal-article","created":{"date-parts":[[2017,4,17]],"date-time":"2017-04-17T06:17:22Z","timestamp":1492409842000},"source":"Crossref","is-referenced-by-count":10,"title":["Risk of Acute Liver Injury With Antiretroviral Therapy by Viral Hepatitis Status"],"prefix":"10.1093","volume":"4","author":[{"given":"Charitha","family":"Gowda","sequence":"first","affiliation":[{"name":"Division of Pediatric Infectious Diseases, Nationwide Children\u2019s Hospital , Columbus, Ohio"},{"name":"Department of Pediatrics, Ohio State University College of Medicine , Columbus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig W.","family":"Newcomb","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania , Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Liu","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania , Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dean M.","family":"Carbonari","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania , Philadelphia"},{"name":"Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania , Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James D.","family":"Lewis","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania , Philadelphia"},{"name":"Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania , Philadelphia"},{"name":"Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly A.","family":"Forde","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania , Philadelphia"},{"name":"Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania , Philadelphia"},{"name":"Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David S.","family":"Goldberg","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania , Philadelphia"},{"name":"Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania , Philadelphia"},{"name":"Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K. Rajender","family":"Reddy","sequence":"additional","affiliation":[{"name":"Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania , Philadelphia"},{"name":"Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania , Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason A.","family":"Roy","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania , Philadelphia"},{"name":"Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania , Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy R.","family":"Marks","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California , Oakland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Schneider","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California , Oakland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay R.","family":"Kostman","sequence":"additional","affiliation":[{"name":"Jonathan Lax Treatment Center, Philadelphia FIGHT , Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet P.","family":"Tate","sequence":"additional","affiliation":[{"name":"VA Connecticut Healthcare System , West Haven, Connecticut"},{"name":"Yale University School of Medicine , New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph K.","family":"Lim","sequence":"additional","affiliation":[{"name":"VA Connecticut Healthcare System , West Haven, Connecticut"},{"name":"Yale University School of Medicine , New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy C.","family":"Justice","sequence":"additional","affiliation":[{"name":"VA Connecticut Healthcare System , West Haven, Connecticut"},{"name":"Yale University School of Medicine , New Haven, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew Bidwell","family":"Goetz","sequence":"additional","affiliation":[{"name":"VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA , Los Angeles, California ; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas A.","family":"Corley","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California , Oakland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent","family":"Lo Re","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, 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