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Hyperbilirubinemia with atazanavir

Posted: Jun 20, 2004

QUESTION:

A young woman was recently started on boosted atazanvir. Within 2 days she developed scleral icterus and had a total and indirect bilirubin levels of 5.8 and 5.4 respectively. Other then the jaundice she is assymtomatic. To complicate matters she is Hep C positive. What are your criteria for stopping the atazanavir and if you stopped would you ever restart? Also if she was not Hepatitis C positive would your criteria change? Thanks J.Borgman, M.D.


  

RESPONSE FROM:   

    The decision to continue atazanavir (Reyataz) in the presence of scleral icterus is not as straightforward as one might assume. I say this because I previously assumed that it was simple, if scleral icterus occurs, you simply stop the drug. What I have learned from clinical experience is that some patients, even with a bilirubin in the 5 range have barely noticeable scleral icterus, and don't need to stop. Other patients at this level of bilirubin must stop - otherwise all day long they have to be explaining to people what was wrong with their eyes. Additionally, some people on Reyataz only develop noticeable scleral icterus when they are sick such as with a viral or bacterial infection.

    So my current criteria for stopping would be icterus or jaundice that is noticeable enough to have a social impact on the patient. I use the same principle for Hepatitis C co-infected patients. Thanks for posting!




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