Torgersen J, Newcomb CW, Carbonari DM, et al. - Researchers conducted a comparative analysis of 18,498 initiators of protease inhibitor (PI)-based direct-acting antivirals (DAAs) for chronic hepatitis C virus-infection matched on propensity score to 18,498 initiators of non-PI-based DAAs, in order to determine the risk of three acute liver injury endpoints, according to advanced hepatic fibrosis/cirrhosis status by FIB-4. Relative to non-PI- initiators, PI initiators displayed higher propensity score-matched hazard ratios of ALT > 200 U/L among those with and without baseline advanced hepatic fibrosis/ cirrhosis (ie, FIB-4 > 3.25 and FIB-4 ≤ 3.25, respectively). PI and non-PI-based DAA initiators did not differ in propensity score-matched hazard ratios of severe hepatic dysfunction or hepatic decompensation; this was observed regardless of baseline advanced hepatic fibrosis/cirrhosis status by FIB-4.