Uglietti Alessia, Novati Stefano, Gulminetti Roberto, Maserati Renato
HIV/AIDS Outpatient Clinic Infectious Disease Dept, Foundation "IRCCS Policlinico San Matteo Hospital", 27100 Pavia, Italy.
J Med Case Rep. 2009 Dec 1;3:9307. doi: 10.1186/1752-1947-3-9307.
Hyperbilirubinemia is a common side effect of the antiretroviral agent atazanavir but is generally reversible upon discontinuation of treatment. We used therapeutic drug monitoring to investigate the occurrence of hyperbilirubinemia in a 49-year-old Hispanic man infected with HIV, following an overdose of ritonavir in ritonavir-boosted atazanavir therapy.
A 49-year-old Hispanic man with HIV who had received several highly active antiretroviral therapy regimens over a number of years including atazanavir-containing regimens, was diagnosed with hyperbilirubinemia. An inappropriate doubling of ritonavir boosting resulted in a high atazanavir C(trough )and an initial rise in bilirubin plasma levels. Bilirubin levels later decreased, probably as a consequence of enzyme induction, while atazanavir plasma concentrations remained elevated.
This article describes an occurrence of hyperbilirubinemia in a man infected with HIV and supports the importance of therapeutic drug monitoring in investigations of hyperbilirubinemia among patients receiving antiretroviral agents. That the patient tolerated exceptionally high atazanavir levels further strengthens the tolerability profile of this drug.
高胆红素血症是抗逆转录病毒药物阿扎那韦的常见副作用，但通常在停药后可逆转。我们通过治疗药物监测，对一名49岁感染HIV的西班牙裔男性在接受利托那韦增强的阿扎那韦治疗时过量服用利托那韦后发生高胆红素血症的情况进行了调查。
一名49岁感染HIV的西班牙裔男性，多年来接受了多种高效抗逆转录病毒治疗方案，包括含阿扎那韦的方案，被诊断为高胆红素血症。利托那韦增强剂量不当加倍导致阿扎那韦谷浓度升高，胆红素血浆水平最初上升。胆红素水平后来下降，可能是酶诱导的结果，而阿扎那韦血浆浓度仍保持升高。
本文描述了一名感染HIV的男性发生高胆红素血症的情况，并支持治疗药物监测在接受抗逆转录病毒药物治疗的患者高胆红素血症调查中的重要性。该患者耐受了异常高的阿扎那韦水平，进一步强化了该药物的耐受性。
