Background: Human immunodeficiency virus (HIV) infection is often complicated with hepatitis virus infection. Antiretroviral therapy (ART) should be initiated with caution for patients with severe virus- or drug-induced acute hepatitis while considering factors that might interfere with the initiation of therapy. Case report: Herein, we present a case of a 67-year-old woman who presented with symptoms of severe liver injury of unknown cause. Laboratory examinations revealed HIV infection. The HIV viral load was high, and treatment with ART was considered. However, a liver biopsy could not be performed because of hyperbilirubinemia and the risk of severe hepatic damage. After assessing the risk of further liver damage, ART was safely administered despite hyperbilirubinemia. Treatment with ART could successfully reduce the viral load and bilirubin levels. Conclusion: ART treatment could be safely used for patients with HIV to reduce the viral load and bilirubin levels while avoiding the risk of liver failure.
