Prevalence and correlates of hyperbilirubinemia among people living with HIV (PLHIV) receiving atazanavir boosted with ritonavir (ATV/r).

BACKGROUND: One of the recommended protease inhibitor treatments for HIV is Atazanavir boosted with Ritonavir (ATV/r). However, hyperbilirubinemia is a well-recognized adverse effect of this therapy. METHODS: This retrospective cross-sectional study analyzed 121 clinical records of people living with HIV (PLHIV) receiving Atazanavir/Ritonavir treatment at the Iranian Research Center for HIV/AIDS between 2014 and 2020. Study variables were extracted from the digital and physical records at the clinic and recorded using a structured data extraction form developed by the research team. For qualitative variables, results are presented as numbers and percentages, and for quantitative variables, results are presented as medians with interquartile ranges (IQR). The authors evaluated the association between demographics, clinical characteristics and laboratory profile with hyperbilirubinemia through univariate and multivariate logistic regression. RESULTS: Hyperbilirubinemia was present in over 85% of the patients, with more than half exhibiting grade III or higher indirect hyperbilirubinemia. No significant associations were found between demographics, ART regimens, or laboratory profiles and hyperbilirubinemia (p > 0.05). CONCLUSIONS: There was a high prevalence of indirect hyperbilirubinemia, with a significant proportion experiencing grade 3-4 elevations. Although no statistically significant associations were observed, it would be valuable to investigate potential genetic predispositions that may make certain individuals more susceptible to developing high-grade hyperbilirubinemia on ATV/r.