Q and A


Bilirubin levels and yellow eyes after switch to atazanavir…

Hi again

My original regime of Atripla once-daily had to be replaced due to severe depression. I am now on Truvada (FTC200mg/tenofovvir245mg) + atazanavir (Reyataz) 300mg and ritonavir (Norvir) 100mg I have been on my new regime now for 6 months and my bilirubin levels are around 150 at my last bloods.

The problem I seem to be experiencing at present is feeling dizzy and slightly faint. My eyes are a bit yellow and very sore.
The best way to describe the feeling is like being in a constant day dream that I can’t snap out of.

Could this be a side effect to my medication or something else?



Pls tell your doctor about your symptoms so your clinic can check for these symptoms.

The normal range for bilirubin is 1 -17. With atazanavir, geeting to five times this upper limit (ie around 70) is a reason to look at alternative doses.

Your doctor can order a TDM test (therapeutic drug monitoring) which measures the levels of atazanavir in your blood before and after any dose adjustment. For example you may be able to take atazanavir at a higher dose (400mg) but may not need the ritonavir boosting.

You can only do this safely with TDM, but this is an easy test to access and use.

Mood changes have also been reported with atazanavir, and although this is not common, the higher drug levels indicated by you bilirubin results, may be relevant.

Info about atazanavir and biirubin is at this link and info about TDM is at this link.


  1. Roy Trevelion

    Hi Elvom,

    Thanks for getting back to us. It’s good that viral load is undetectable.

    That’s because you can switch to other meds. And then, if you get side effects to the new meds you should be able to switch back to atazanavir.

    Please check this with your doctor. Please let us know how you get on.

  2. Elvom

    The viral load is undetectable. I don’t think they still test for CD4 count. Last time I asked, my doctor told me the CD4 count is no longer important. So, they only do the viral load count.

    As I said in my original message, i can’t remember the name of the option but I am on the second line of the ART.

  3. Roy Trevelion

    Hi Elvom,

    I’m sorry that this side effect of Atazanavir is distressing. But what other treatment options did your doctor suggest?

    However, it’s not easy to say if we will get a reported side effect from our HIV meds.

    Please let us know what meds your doctor suggests. And if you have access to your CD4 and viral load results, please tell us what they are.

  4. Elvom

    The yellowing of the eyes is specifically very distressing to me. I have been taking Atazanavir for almost 5 years and honestly, I’m tired. Everyone keeps asking me why my eyes are yellow and looking in the mirror, I don’t like the way I look. It’s horrible.

    I talked to my doctor for a possible change but i didn’t like the other options. Apparently the side effects of the other option whose name I can’t remember include diarrhea and that scared me and I thought I would rather remain with yellow eyes than struggling to look for a toilet every time. But I definitely hate the way my eyes look. I look even worse in pictures.


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