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got jaundice due to atazonavir
Dec 4, 2010

Hello sir,i am a doctor. i am taking tenofovir+lamivudine+Atazanavir for post exposure prophylaxis. I got yellow discoloration of sclera and my bilirubin level is 3.5. i also having fever. What should i do.

Response from Dr. Young

Hello Doctor and thank you for your post.

First, elevated bilirubin and scleral icterus (or jaundice) is a common, but usually medically insignificant complication of atazanavir (Reyataz) use. The hyperbilirubminemia resolves once the medication is discontinued and can be particularly problematic for persons who have baseline Gilbert's syndrome.

My concern is the 3-drug regimen that you're taking- tenofovir and ataznavir have a significant drug-drug interaction that results in inadequate atazanavir levels. Recommended dosing of the regimens that include the two meds includes ritonavir (Norvir) for PK boosting (tenofovir + lamivudine with ritonavir 100 mg + atazanavir 300 mg, all once-daily, with food).

Depending on your exposure, it might be reasonable to only be on the tenofovir+lamivudine (as per current treatment guidelines for post-exposure prophylaxis). This strategy could avoid the icterus that you're experiencing. Alternatively, a different medication could be substituted for the 'taz.

As for fever, much depends on your additional symptoms and findings. The differential diagnosis could be quite broad, ranging from infection (of many different things, especially following a potential exposure) to drug reaction. I'd suggest seeking evaluation if the fever is high or persists.

I hope this helps and wish you well, BY

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