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Bilirubin more than 80 mmol/l - what shall I do?
Jan 7, 2009

Dear doctors, I have been on combivir, reyataz and norvir scheme for 1,5 already. my viral load is undetectable, CD count is 680. No signs of liver damage, but always very high levels of total bilirubin (80-100), direct (15-20). Shall I change my meds because of this? Is it dangerous to have such high levels of bilirubin - is it toxic? Thank you!

Response from Dr. Henry

High bilirubin levels (mostly indirect) is seen in < 5-7% of patients taking atazanavir and if persistent/severe (such as visible jaundice) then a switch to one of many alternative regimens is considered (such as boosted lopianvir, darunavir, fosamprenavir, efavirenz, or raltegarvir). Usually the problem is mostly cosmetic with no evidence of actual liver damage. KH

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