{"id":2219,"date":"2023-03-01T12:00:00","date_gmt":"2023-03-01T12:00:00","guid":{"rendered":"http:\/\/moomango.co.uk\/guides\/?page_id=2219"},"modified":"2023-03-13T07:45:01","modified_gmt":"2023-03-13T07:45:01","slug":"bilirubin-and-jaundice","status":"publish","type":"page","link":"https:\/\/i-base.info\/guides\/side\/bilirubin-and-jaundice","title":{"rendered":"Increased bilirubin and jaundice (yellow skin and eyes)"},"content":{"rendered":"

Bilirubin is an orange waste product; Hyper = increased; aemia = \u2018in blood\u2019<\/em><\/p>\n

Associated drugs: atazanavir<\/a> (Reyataz); Evotaz<\/a> (atazanavir+cobicistat);\u00a0indinavir<\/a> (Crixivan, no longer\u00a0used).<\/strong><\/p>\n

An increase in bilirubin (called hyperbilirubinaemia) is a common side effect of atazanavir. More than 50% of people who use this protease inhibitor\u00a0will show increases in a laboratory test,\u00a0especially when boosted by ritonavir<\/a> (Norvir) or cobicistat<\/a> (Tybost).<\/strong><\/p>\n

Small increases\u00a0are not causing any damage to your body. If levels reach higher than five times the upper range for normal, this is usually the time to change or modify treatment.<\/p>\n

These increases are usually mild and less than 10% of people switch to an alternative drug.<\/p>\n

When symptoms are noticable, this includes your skin, or the white of the eyes being more yellow. Many people like it because it can look like a light sun tan.<\/p>\n

Indinavir can also increase bilirubin, though this drug is rarely used.<\/p>\n

What is bilirubin?<\/h2>\n

Bilirubin is an orange-yellow part of bile. Bile is the bright green fluid secreted by the liver to help digestion.<\/p>\n

Bilirubin is mainly formed by the normal breakdown of haemoglobin (the protein in red blood cells that transport oxygen).<\/p>\n

Bilirubin normally passes through the liver. It is then excreted as bile through the intestines.<\/p>\n

When this process is interrupted, excess bilirubin stains other body tissues yellow. Fatty tissues like skin, eye tissue and blood vessels are most affected.<\/p>\n

Two types of bilirubin<\/h2>\n

There are two types of bilirubin in the blood.<\/p>\n

    \n
  1. Unconjugated (indirect) bilirubin is insoluble in water. This is the bilirubin before it reaches the liver<\/li>\n
  2. Conjugated (direct) bilirubin has been converted to soluble bilirubin in the liver.\u00a0 It then goes into the bile to be stored in the gall bladder or sent to the intestines.<\/li>\n<\/ol>\n

    Routine blood tests for total bilirubin measure both unconjugated and conjugated bilirubin.<\/p>\n

    Increases in bilirubin with atazanavir are of unconjugated bilirubin. This is very common with atazanavir.<\/p>\n

    People who have lower levels of the enzymes responsible for converting bilirubin in the liver will be at a higher risk of increases in bilirubin from atazanavir. This has been linked to genetic factors.<\/p>\n

    Increases in congugated bilirubin are linked with a range of illnesses and conditions. This includes jaundice associated with hepatitis and cirrhosis, anaemia, Gilbert\u2019s disease and sickle cell disease. Jaundice is common in babies. Very high levels in babies can cause permanent damage.<\/p>\n

    Normal bilirubin levels and when to change<\/h2>\n

    Normal values might vary between different labs but are within the following ranges.<\/p>\n