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Elevated Billirubin & Reyataz
Mar 22, 2006

First let me thank you all for being here to answer questions. It has been so helpful to me.

I am newly diagnosed and have been on boosted Reyataz with Truvada for 6 months. My viral load is undectable and CD4% is 28%. I also suffer fr Gilberts syndrome and always have had an elevated billirubin. My eyes are yellow and my skin looks somewhat jaundiced. My total billirubin level is 8.6 and direct billirubin is .2

My ID doc would like to switch me to Kaletra, but my cholesterol is 216 and Triglycerides are 215. For that reason as well as blood glucose at 97 fasting I would like to stay the course with the boosted Reyataz. Also I am concerned with lipodystrophy effects of Kaletra should they be more pronunced then boosted Reyataz.

What is your opinion? Does the high billirubin have any health consequences? Would you recommend for me the Kaletra over the Reyataz?

Tks Again!

Response from Dr. Henry

Good question. Though pxs with Gilbert's or protease inhibitor increased levels of indiredt bilirubin generally seem to do well, I am uneasy with high levels like you have experienced. I have several pxs with levels around 5 who don't want to switch off Reyataz but no one at your level who has not switched. To my knowledge there is no clear threshold for a serious health risk. You could consider a trial switching to Kaletra or boosted Invirase or unboosted or unboosted Lexiva or Sustiva/Viramune so you have a number of options to discuss with your HIV specialist. KH

CD4 is up, but so is CD8

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