We compare changes in alanine and aspartate aminotransferases (ALT and AST) and total bilirubin (TB) before and 365 days after buprenorphine prescription among a clinical cohort of patients with and without HIV infection.

No clinically significant changes were observed in median ALT, AST and TB among HIV-infected and uninfected patients in the Veteran's Aging Cohort Study who were prescribed buprenorphine and these changes did not differ between the two groups.

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) prescribed buprenorphine were more likely to have the composite endpoint of liver enzyme elevation, total bilirubin elevation, or drug induced liver injury. There were no significant associations with alcohol use disorder or prescription of other potentially hepatotoxic medications after adjustment for HIV/HCV status.

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.