Dear Dr.

I was succesfully supressed under Kaletra/truvada (VL < 40) but switched to Reyataz/norvir/truvada due to persistent intestinal discomfort (i'm a sales rep... finding a toilet in a traffic jam is a problem). The reyataz combo works wonders: no more diarrhea. I am getting a lot of comments on my yellow looking skin though (i've got a pale skin tone, the yellow really stands out). I've been on the combo for 4 weeks now. My previous hiv doctor did point out that i have elevated bilirubin anyway (regardless of reyataz), due to Gilbert's syndrome. Can i expect the yellowing to go down? Are there any meds that might help decrease the bilirubin concentration (ursodiol? diuretic?)? Any "proven" natural remedies?

Thanks for the help.

Jimcr

There may be some fluctuations in the bilirubin level over time (hydration might help some) but I cannot endorse any particular drug or manuver as consistently effective to reduced the bilirubin (decreasing the jaundice). It may be worthwhile to check the indirect bilirubin level to see how high it is (if very high >>4-5 the less likely that the problem will easily resolve). If you stay jaundiced then a switch to boosted fosamprenavir or darunavir, efavirenz, or raltegravir are other possibilities (depending on resistance history). KH