Glecaprevir-Pibrentasvir and Ethinyl Estradiol-Induced Liver Injury in a Patient Without Cirrhosis.

Most drug liver injury cases are the result of an unexpected interaction with medications. We present a 33-year-old woman, four months postpartum, on ethinyl estradiol/norgestrel, who presented in the ED with nausea, vomiting, abdominal pain, and severe pruritus six weeks after starting glecaprevir-pibrentasvir (GP) treatment. The patient was suspected to have a drug-induced liver injury (DILI), and GP was discontinued. Other potential causes of liver injury were ruled out via labs, imaging, and liver biopsy. The patient's liver function significantly improved after discontinuing GP. Few cases of DILI secondary to GP have been reported. However, to the best of our knowledge, DILI from the interaction of ethinyl estradiol and GP does not exist in published literature. In our case, DILI was likely due to the effect of GP and ethinyl estradiol on the liver's cytochrome 450 (CYP 450) system. The aim of this report is to raise awareness and improve pharmacovigilance, especially in patients receiving medications that are metabolized by the liver's CYP 450 system. Early detection of DILI secondary to drug-interaction and discontinuation of the culprit medication is the mainstay of treatment. However, there is a lack of evidence-based management strategies for premature discontinuation of GP in the setting of DILI while treating chronic hepatitis C virus (HCV) infection. Further investigations are warranted.

Association of Opioid Use With Cardiometabolic Disease Risk Factors: Evidence From the 2009-2018 National Health and Nutrition Examination Survey.

Objective To investigate the association between opioid drug use and cardiometabolic risk factors in an adult sample data acquired from the National Health and Nutrition Examination Survey (NHANES). Methods A retrospective cross-sectional analysis was performed using the data from the NHANES for the period 2009-2018 provided by the Centers for Disease Control and Prevention (CDC), amounting to a total of N = 10,032 eligible participants. The data were analyzed to study the relationship between opioid drug use (dividing into four dichotomy groups: drug use (DU) group, illicit drug use (IDU) group, repeated drug use (RDU) group, and current drug use (CDU) group) and cardiometabolic disease risk factors (CDRF) (i.e., hypertension, abnormal triglyceride levels, low-level of high-density lipoproteins (HDLs), high waist circumference, insulin resistance, serum cotinine levels, higher C-reactive protein, hypercholesterolemia, and increased BMI). The statistical correlation was evaluated using the chi-square analysis, and a p-value of less than 0.05 was considered statistically significant. Alcohol use, age, race, ethnicity, education level, and poverty to income ratio (PIR) were analyzed as covariates.  Results Overall, our analysis found that males were more likely than females (p ≤ 0.001) to have ever reported using drugs at least once in their lifetime. In fact, males were more likely than females to report ever using cocaine (p = 0.01), heroin (p = 0.01), and marijuana (p = 0.01). Additionally, males were significantly more likely than females to disclose the current use of illicit drugs (p = 0.002), and also tend to have consumed more with at least 12 alcoholic beverages per year (p < 0.001). Overall, we found no association between substance use and having a cluster of three or more CDRF variables for both males and females. Conclusion Study results highlight the prevalence of gender differences in DU and its reporting. With the rising popularity of illicit drugs, clinicians must be aware of its association with CDRF.