Main Article Content

Abstract

Background


Hyperbilirubinemia is frequently observed in HIV (Human Immunodeficiency Virus) patients treated with Atazanavir containing antiretroviral regimen in the dose of 300 mg once daily. However, little is known about the incidence of Atazanavir-associated hyperbilirubinemia in Asian population. Hyperbilirubinemia is defined as an excess of bilirubin in blood either conjugated or unconjugated.


Aim


To estimate the incidence of Atazanavir associated hyperbilirubinemia in HIV patients receiving second line antiretroviral regimen advocated by National AIDS Control Organisation (NACO) by measuring serum bilirubin levels.


Materials and Methods


The study was done in 100 HIV-infected patients attending ART Plus centre at a tertiary care centre receiving Atazanavir regimen for a period of 12 months. The bilirubin levels in blood were estimated by MALOY & EVELYN METHOD.


Results


The incidence of grade I hyperbilirubinemia was 26%, grade II was 24%, grade III was 48% & grade IV 2%. The Study data suggested that Atazanavir-associated hyperbilirubinemia is common and self limiting.


Conclusion


It was observed that most of the HIV/AIDS patients receiving Atazanavir containing ART regimens developed hyperbilirubinemia, so these patients should be regularly monitored for Atazanavir induced hyperbilirubinemia.

Keywords

HIV Acquired Immunodeficiency Syndrome Atazanavir Hyperbilirubinemia NACO

Article Details

How to Cite
Savithri Desai, Harish.G.Bagewadi, & Harinika G. (2021). Hyperbilirubinemia during Atazanavir treatment in HIV/AIDS patients taking second line ART drugs. International Journal of Research in Pharmacology & Pharmacotherapeutics, 7(1), 1-6. Retrieved from https://ijrpp.com/ijrpp/article/view/226

References

  1. [1]. Global Health Observatory, WHO. Available from: http://www.who.int/gho/hiv/en/.
  2. [2]. Top 10 causes of death, WHO. Available from: http://www.who.int/mediacentre/ factsheets/fs310/en/index.html [Accessed in 2016].
  3. [3]. List of countries by HIV/AIDS prevalence rate, 2012. Available from:
  4. http://www.en.wikipedia.org/wiki/ List_of_countries_by_HIV/AIDS_adult_prevalence_rate [Accessed 2012].
  5. [4]. Coffin JM: HIV Population Dynamics in vivo: Implication for genetic variation, Pathogenesis and therapy, Science 267, 1995, 483-489.
  6. [5]. Fauci A.S., Braunwald E., Kasper D.L., Hauser S.L., Longo D.L., Jameson J.L., Loscalzo J. Harrison's principles of internal medicine. McGraw-Hill Publishers, 2008, 1137-1203.
  7. [6]. NACO, April 2011. ‘National guidelines on second line ART.’ Ministry of health and family welfare. Government of India.
  8. [7]. Havlir, DV., SD. O'Marro. Atazanavir: New Option for Treatment of HIV Infection: J. Clin Infect Dis., 38, 2004, 1599–1604.
  9. [8]. Bertram G. Katzung, Basic and Clinical Pharmacology. McGraw Hill Publishers, 2009, 845 – 873.
  10. [9]. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection, recommendations for a public health approach. Geneva: World Health Organization; second edition
  11. (http://www.who.int/hiv/pub/arv/arv-2016/en/, accessed 2016).
  12. [10]. Swainston Harrison, T and LJ. Scott, Atazanavir: A Review of its use in the management of HIV Infection., 65(16), 2005, 2309-2336. 2017.
  13. [11]. O’Mara, E., D.Randall, J. Passarell, S. Steinberg and Grasela D, Population pharmacodynamic assessment of Atazanavir exposure, uridine diphosphate-glucuronosyl transferase (UGT) 1a1 genotype and safety in healthy subjects. 42nd Interscience Congress on Antimicrobial Agents and Chemotherapy, 2002, 27-30. Abstract A-1253
  14. [12]. Zucker, SD., X. Qin, SD. Rouster, F. Yu, RM. Green, P. Keshavan, J. Feinberg and KE. Sherman. Mechanism of indinavir-induced hyperbilirubinemia. Proc Natl Acad Sci USA., 98, 2001, 12671-12676.
  15. [13]. Rotger, M., P. Taffe, G. Bleiber, HF. Gunthard, H. Furrer, P. Vernazza, H. Drechsler, E. Bernasconi, M. Rickenbach and A. Telenti. Gilbert Syndrome and the development of Antiretroviral Therapy- associated Hyperbilirubinemia. J Infect Dis., 192, 2005, 1381–1386.
  16. [14]. Pyoeng Gyun Choe, Wan Beom Park, Jin Su Song, Nak Hyun Kim, Kyoung Ho Song, Sang Won Park, Hong Bin Kim, Nam Joong Kim and Myoung don Oh,. Incidence of Atazanavir associated Hyperbilirubinemia in Korean HIV Patients. J.Korean Med Sci., 25(10), 2010, 1427-1430.
  17. [15]. Subashini D et al, 2016. Incidence of Atazanavir- associated adverse drug reactions in second -line drugs treated south Indian HIV-1 infected patients. Indian J Pharmacol. 48(5), 2016, 582–585.
  18. [16]. Pujades-Rodrı´guez M et al., 2008. ‘Second-line antiretroviral therapy in resource-limited settings: the experience of Me´decins Sans Frontie`res.’ AIDS 22(11), 2008, 1305–1312.
  19. [17]. Guha SK et al., 2011. ‘Effectiveness of addition of zidovudine to second line antiretroviral regimen of tenofovir, lamivudine and lopinavir/ritonavir in patients failing thymidine analogue based first line atiretroviral therapy in India.’ Available from: pag.ias2011.org/Abstracts.aspx?AID=3419 [Accessed 2012].
  20. [18]. Cheryl, Mc Donald., Uy. Jonathan, Hu. Wenhua, Victoria. Wirtz, Salome. Juether, David. Butcher, Donnie. McGrath, Awny. Farajallah and Graeme Moyle. AIDS Patient Care and STDs, 26(5), 2012, 259-264.
  21. [19]. Rotger, M., P. Taffe, G. Bleiber, HF. Gunthard, H. Furrer, P. Vernazza, H. Drechsler, E. Bernasconi, M. Rickenbach and A. Telenti, Gilbert Syndrome and the development of Antiretroviral Therapy- associated Hyperbilirubinemia. J Infect Dis., 192, 2005, 1381–1386.
  22. [20]. Robert L. Murphy et al., 2003. “Dose-ranging, randomized, clinical trial of Atazanavir with lamivudine and stavudine in antiretroviral-naïve subjects”. AIDS 17, 2003, 2603–2614.