Q and A

Question

Does increased bilirubin from atazanavir damage my liver?

thank you for the quick response to our questions.
l have been to see my consultant today and one of my labs was abnormal ie the bilirubin was 42 instead of 20dcl. l am taking the following medication, Reyataz (atazanavir), Norvir (ritonavir) and Kivexa (abacavir + 3TC), all taken once a day.

My worry is that l do not show any sign of jaundice at all. The other thing is that l was so comfortable with this regime and l am afraid to have to go another phase of worry with side effects.

My consultant said l should not worry about the rise, but l can’t stop worry if something is happening to liver l need to know.

Is there something that can be done to reverse the rise?

Answer

Mild increases in bilirubin when they are caused by atazanavir are not doing any damage to your liver. This is because the type of bilirubin that is increased is ‘unconjugated’ or ‘indirect’ bilirubin, which is insoluble bilirubin before it is processed by the liver.

The normal range for a total bilirubin test is 0-17 mmol/L.

Modifying the combination by changing the dose of atazanavir or the way it is boosted by ritonavir, or changing to a different drug is only recommended if levels reach 5 times the upper limit of normal (ULN) – ie when they reach 60-70 mmol/L.

Symptoms of jaundice only become noticable (yellowish skin or eyes) at levels over 40 mmol/L, so this is why you have not noticed anything.

More information about this is included in the section on jaundice and bilirubin in the i-Base guide to side effects.

Your consultant is giving you good advice.

If the bilirubin continues to rise, or you get jaundice, you could ask for your drug levels to be checked in case these levels are naturally high, and perhaps the ritonavir and atazanavir dose could be modified.

You must only do this after the drug level test as reducing your dose could otherwise lead to levels that are too low, and you would be a risk of getting resistance to those drugs.

Unless it rises higher (above 60-70) there is no need to worry.

2 comments

  1. Simon Collins

    Hi Stella

    If you still have cirrhosis (cirrhosis is difficult to reverse) or ongoing liver problems (ie HCV coinfection) then your doctor should be monitoring your liver enzymes carefully, and you may need to have other monitoring.

    Ask your doctor about ‘unconjugated’ bilirubin to put your mind at rest.

    Also, a spanish study at the recent IAS conference in Sydney reported that both ritonavir-boosted or unboosted atazanavir was safe and well tolerated in patients with cirrhosis.

  2. stella

    Thank you for this information, l lay awake last night thinking the worst is happening to my liver. One time l was diagnosed with cirrhosis of the liver.
    l am so relieved, keep up the good work. Most appreciated.

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