Question
I am taking atazanavir, will my billirubin levels fall in time?
14 February 2012. Related: All topics.
I have been using atanazavir for 2 months. Although it is working well, I am increasingly self-conscious about the effects of the increased bilirubin.
My face has a lot more colour than it did but worse is the change to my eyes. They are not really yellow but they do look cloudy.
How likely is it that the bilirubin level will fall in time?
I would rather not switch drugs but equally I do not want to look strange.
Answer
I am sorry you are having problems with your bilirubin levels.
An increase in bilirubin (called hyperbilirubinaemia) is a common side effect of atazanavir. More than 50% of people who use this drug, especially when boosted by ritonavir, will show increases in a laboratory test.
One of the problems with protease inhibitors such as atazanavir, which are boosted with ritonavir, is that the levels of drug in the body can vary depending on the individual. This is not causing any damage to your body, until levels get higher than five times normal. Your doctor can test your levels with a Therapeutic Drug Monitoring (TDM) test. This test measures the level of drugs in your blood. For more information on TDM please follow this link.
If you are not experiencing other side effects, there are some things you can try without having to switch medication.
If your drug levels are too high your doctor has two options. To reduce the amount of atazanavir and ritonavir you take or stop the ritonavir and slightly increase the atazanavir (e.g. from 300 to 400mg per day). It is fine to change the levels of these drugs if your viral load is undetectable. If you still have a detectable viral load your doctor may be less keen to try different dosages of atazanavir.
For more information about atazanavir-induced hyperbilirubinaemia please follow this link.
If you decide to try this and you are still not happy, then an option may be to change the atazanavir altogether. I can appreciate that you are not too keen to switch drugs. However, you should not have to put up with side effects if they are affecting your quality of life to a large extent. And you may find that there are other drugs which give you fewer side effects.
Best wishes
I took atazanavir for 4 years. After an initial yellow period (very moderate) the bilirubin thing settled down. But my yellow eyes came back intermittently, not often but enought to be significant. I changed to a different drug and this went away. Now I go out, exercise as normal, etc. The on/off yellowing was making me a recluse. Otherwise I was very happy on atazanavir.