Study of atazanavir-induced hyperbilirubinemia among HIV patients on second-line anti-retroviral therapy

Abstract

Introduction: Ritonavir-boosted atazanavir (ATV/r) is the preferred second-line protease inhibitor option for HIV patients as per the NACO guidelines. Atazanavir is a protease inhibitor with several advantages including once-daily dosing, low pill burden, and favorable effect on lipid profile compared with other protease inhibitors. Atazanavir-induced hyperbilirubinemia is not widely studied in the Indian population. Aim: The aim is to study the occurrence of atazanavir-induced hyperbilirubinemia in HIV patients receiving second-line antiretroviral therapy (ART) and its outcome. Materials and Methods: One hundred and ten HIV patients treated with ATV/r-based second-line anti-retroviral regimen at a tertiary care hospital were included in the study and followed up for at least 12 months. Liver function tests were measured at baseline (at the time of initiation of ATV/r), at 6 months and 12 months of second-line ART. Results: The cumulative incidence of hyperbilirubinemia in the study population was 42.72% (n = 47). However, atazanavir-induced hyperbilirubinemia was self-limiting and did not mandate change in regimen. Conclusion: A significant number of patients on ATV/r-based second-line ART developed indirect hyperbilirubinemia. There was no significant elevation in liver enzymes. Most of the patients tolerated ATV/r-based regimen well and there was no need for discontinuation/change of regimen. Patients on ATV/r-based regimen must be followed up closely and counseled regarding adherence to therapy.

Keywords

• atazanavir
• hiv patients
• hyperbilirubinemia