Suppr超能文献

丁丙诺啡在感染和未感染HIV的阿片类药物使用障碍患者中的肝脏安全性:丙型肝炎病毒感染的作用

Hepatic Safety of Buprenorphine in HIV-Infected and Uninfected Patients With Opioid Use Disorder: The Role of HCV-Infection.

作者信息

Tetrault Jeanette M, Tate Janet P, Edelman E Jennifer, Gordon Adam J, Lo Re Vincent, Lim Joseph K, Rimland David, Goulet Joseph, Crystal Stephen, Gaither Julie R, Gibert Cynthia L, Rodriguez-Barradas Maria C, Fiellin Lynn E, Bryant Kendall, Justice Amy C, Fiellin David A

机构信息

Department of Internal Medicine, Yale University School of Medicine, New Haven, CT.

Department of Internal Medicine, Yale University School of Medicine, New Haven, CT; VA Connecticut Health Care System, West Haven, CT.

出版信息

J Subst Abuse Treat. 2016 Sep;68:62-7. doi: 10.1016/j.jsat.2016.06.002. Epub 2016 Jun 6.

Abstract

INTRODUCTION

Individuals with HIV and hepatitis C (HCV) infection, alcohol use disorder, or who are prescribed potentially hepatotoxic medications may be at increased risk for buprenorphine (BUP) associated hepatotoxicity.

MATERIALS AND METHODS

We examined a cohort of HIV-infected and uninfected patients receiving an initial BUP prescription between 2003 and 2012. We compared changes in alanine and aspartate aminotransferases (ALT and AST) and total bilirubin (TB) stratified by HIV status. We identified cases of liver enzyme elevation (LEE), TB elevation (TBE), and conducted chart review to assess for cases of drug induced liver injury (DILI) and death. We examined associations between age, sex, race, HIV-infection, HCV-infection, alcohol use disorder, and prescription of other potentially heptatotoxic medications with the composite endpoint of LEE, TBE, and DILI.

RESULTS

Of 666 patients prescribed BUP, 36% were HIV-infected, 98% were male, 60% had RNA-confirmed HCV infection, 50% had a recent diagnosis of alcohol use disorder, and 64% were prescribed other potentially hepatotoxic medications. No clinically significant changes were observed in median ALT, AST and TB and these changes did not differ between HIV-infected and uninfected patients. Compared with uninfected patients, HIV-infected (OR 7.3, 95% CI 2.1-26.1, p=0.002), HCV-infected (OR 4.9 95% CI 1.6-15.2, p=0.007) or HIV/HCV co-infected patients (OR 6.9, 95%CI 2.1-22.2, p=0.001) were more likely to have the composite endpoint of LEE, TB elevation or DILI, in analyses that excluded 60 patients with evidence of pre-existing liver injury. 31 patients had LEE, 14/187 HIV-infected and 17/340 uninfected (p=0.25); 11 had TBE, including 9/186 HIV-infected and 2/329 uninfected (p=0.002); 8 experienced DILI, 4/202 HIV-infected and 4/204 uninfected (p=0.45). There were no significant associations with alcohol use disorder or prescription of other potentially hepatotoxic medications after adjustment for HIV/HCV status.

CONCLUSIONS

Liver enzymes and TB are rarely elevated in HIV-infected and uninfected patients receiving BUP. Risk of hepatotoxicity was greater in individuals infected with HIV, HCV, or HIV/HCV co-infection, who may benefit from increased monitoring.

摘要

引言

感染人类免疫缺陷病毒(HIV)和丙型肝炎病毒(HCV)、患有酒精使用障碍或正在服用可能具有肝毒性药物的个体,可能面临丁丙诺啡(BUP)相关肝毒性风险增加的情况。

材料与方法

我们研究了一组在2003年至2012年间首次接受BUP处方的HIV感染和未感染患者。我们比较了按HIV状态分层的丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)和总胆红素(TB)的变化。我们确定了肝酶升高(LEE)、TB升高(TBE)的病例,并进行病历审查以评估药物性肝损伤(DILI)和死亡病例。我们研究了年龄、性别、种族、HIV感染、HCV感染、酒精使用障碍以及其他潜在肝毒性药物处方与LEE、TBE和DILI复合终点之间的关联。

结果

在666例开具BUP处方的患者中,36%为HIV感染者,98%为男性,6%经RNA确认感染HCV,50%近期诊断为酒精使用障碍,64%开具了其他潜在肝毒性药物。未观察到ALT、AST和TB中位数有临床显著变化,且HIV感染和未感染患者之间的这些变化无差异。与未感染患者相比,在排除60例有既往肝损伤证据的患者的分析中,HIV感染者(比值比[OR] 7.3,95%置信区间[CI] 2.1 - 26.1,p = 0.002)、HCV感染者(OR 4.9,95% CI 1.6 - 15.2,p = 0.007)或HIV/HCV合并感染者(OR 6.9,95% CI 2.1 - 22.2,p = 0.001)更有可能出现LEE、TB升高或DILI复合终点。31例患者出现LEE,其中14/187例为HIV感染者,17/340例为未感染者(p = 0.25);11例出现TBE,包括9/186例HIV感染者和2/329例未感染者(p = 0.002);8例发生DILI,4/2%例为HIV感染者,4/204例为未感染者(p = 0.45)。在调整HIV/HCV状态后,与酒精使用障碍或其他潜在肝毒性药物处方无显著关联。

结论

接受BUP治疗的HIV感染和未感染患者中,肝酶和TB很少升高。HIV、HCV或HIV/HCV合并感染个体的肝毒性风险更大,他们可能受益于加强监测。

相似文献

1
Hepatic Safety of Buprenorphine in HIV-Infected and Uninfected Patients With Opioid Use Disorder: The Role of HCV-Infection.
J Subst Abuse Treat. 2016 Sep;68:62-7. doi: 10.1016/j.jsat.2016.06.002. Epub 2016 Jun 6.
3
Hepatitis C virus infection and pain sensitivity in patients on methadone or buprenorphine maintenance therapy for opioid use disorders.
Drug Alcohol Depend. 2015 Aug 1;153:286-92. doi: 10.1016/j.drugalcdep.2015.05.011. Epub 2015 May 22.
4
Hepatic safety and lack of antiretroviral interactions with buprenorphine/naloxone in HIV-infected opioid-dependent patients.
J Acquir Immune Defic Syndr. 2011 Mar 1;56 Suppl 1:S62-7. doi: 10.1097/QAI.0b013e31820a820f.
8
Hepatic safety and antiretroviral effectiveness in HIV-infected patients receiving naltrexone.
Alcohol Clin Exp Res. 2012 Feb;36(2):318-24. doi: 10.1111/j.1530-0277.2011.01601.x. Epub 2011 Jul 28.
10
The Impact of Hepatitis C Virus Infection on Buprenorphine Dose in Pregnancy.
Am J Perinatol. 2020 Jan;37(1):73-78. doi: 10.1055/s-0039-1698838. Epub 2019 Oct 26.

引用本文的文献

1
Prevalence and Medication Treatment of Opioid Use Disorder Among Primary Care Patients with Hepatitis C and HIV.
J Gen Intern Med. 2021 Apr;36(4):930-937. doi: 10.1007/s11606-020-06389-7. Epub 2021 Feb 10.

本文引用的文献

1
Buprenorphine-naloxone treatment in opioid dependence and risk of liver enzyme elevation: results from a 12-month observational study.
Am J Addict. 2014 Nov-Dec;23(6):563-9. doi: 10.1111/j.1521-0391.2014.12131.x. Epub 2014 Sep 22.
2
Effects of HCV seropositive status on buprenorphine pharmacokinetics in opioid-dependent individuals.
Am J Addict. 2014 Jan-Feb;23(1):34-40. doi: 10.1111/j.1521-0391.2013.12052.x. Epub 2013 Jun 10.
4
The next therapeutic challenge in HIV: polypharmacy.
Drugs Aging. 2013 Aug;30(8):613-28. doi: 10.1007/s40266-013-0093-9.
6
Brief versus extended counseling along with buprenorphine/naloxone for HIV-infected opioid dependent patients.
J Subst Abuse Treat. 2012 Dec;43(4):433-9. doi: 10.1016/j.jsat.2012.07.011. Epub 2012 Aug 29.
7
Buprenorphine/Naloxone and methadone effects on laboratory indices of liver health: a randomized trial.
Drug Alcohol Depend. 2013 Feb 1;128(1-2):71-6. doi: 10.1016/j.drugalcdep.2012.08.002. Epub 2012 Aug 22.
8
9
Oral substitution treatment of injecting opioid users for prevention of HIV infection.
Cochrane Database Syst Rev. 2011 Aug 10(8):CD004145. doi: 10.1002/14651858.CD004145.pub4.
10
Hepatic safety and lack of antiretroviral interactions with buprenorphine/naloxone in HIV-infected opioid-dependent patients.
J Acquir Immune Defic Syndr. 2011 Mar 1;56 Suppl 1:S62-7. doi: 10.1097/QAI.0b013e31820a820f.

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍。

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

文档翻译

学术文献翻译模型,支持多种主流文档格式。

立即体验