Effect of Ritonavir-boosting on Atazanavir Discontinuation due to Jaundice in HIV-infected Koreans

Pyoeng Gyun Choe; Wan Beom Park; Kyoung-Ho Song; Ji-Hwan Bang; Eu Suk Kim; Sang-Won Park; Hong Bin Kim; Nam Joong Kim; Myoung-don Oh; Kang Won Choe

doi:10.3947/ic.2012.44.3.175

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Choe, Park, Song, Bang, Kim, Park, Kim, Kim, Oh, and Choe: Effect of Ritonavir-boosting on Atazanavir Discontinuation due to Jaundice in HIV-infected Koreans

Original Article

Infection & Chemotherapy

Infection & Chemotherapy 2012; 44(3): 175-179.

Published online: 30 June 2012

DOI: https://doi.org/10.3947/ic.2012.44.3.175

Effect of Ritonavir-boosting on Atazanavir Discontinuation due to Jaundice in HIV-infected Koreans

Pyoeng Gyun Choe, Wan Beom Park, Kyoung-Ho Song, Ji-Hwan Bang, Eu Suk Kim, Sang-Won Park, Hong Bin Kim, Nam Joong Kim, Myoung-don Oh, Kang Won Choe

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

Correspondence to Wan Beom Park. Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongro-gu, Seoul 110-744, Korea. Tel: +82-2-2072-3596, Fax: +82-2-762-9662, wbpark1@snu.ac.kr

Received 26 March 2012 Revised 2 May 2012 Accepted 3 May 2012

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Data regarding differences of intolerance between a ritonavir-unboosted and a ritonavir-boosted atazanavir regimen in HIV-infected Koreans is limited.

Materials and Methods

A review was conducted of the incidence of severe hyperbilirubinemia (serum total bilirubin >3.1 mg/dL) and discontinuation of atazanavir in HIV-infected patients who had received an atazanavir-containing regimen at Seoul National University Hospital from 2005 to 2009. Patients with active liver disease were excluded from the study.

Results

Of a total of 335 patients receiving an atazanavir-containing regimen, 145 (43.3%) received treatment with a ritonavir-boosted regimen. The cumulative incidence of severe hyperbilirubinemia at three months was 40.5% in patients receiving a ritonavir-boosted atazanavir regimen and 21.4% in patients receiving an un-boosted atazanavir regimen (P<0.001). The cumulative incidence of severe hyperbilirubinemia at 12 months was 58.5% in patients receiving a ritonavir-boosted regimen and 41.3% in those receiving an un-boosted regimen (P=0.008). The proportion of drug discontinuation due to jaundice during the 12-month period was 11.7% in patients receiving a ritonavir-boosted regimen and 5.3% in those receiving an un-boosted regimen (P=0.035).

Conclusions

Occurrence of severe hyperbilirubinemia and discontinuation of atazanavir due to jaundice was significantly more common in HIV-infected Koreans who received a ritonavir-boosted atazanavir regimen than in those who received a ritonavir-un-boosted atazanavir regimen.

Keywords: HIV, Atazanavir, Ritonavir, Hyperbilirubinemia, Jaundice

Figures and Tables

Figure 1

Cumulative incidence of hyperbilirubinemia among HIV-infected Koreans receiving an atazanavir-containing regimen. (A) Any grade hyperbilirubinemia (serum total bilirubin >1.2 mg/dL), (B) severe hyperbilirubinemia (serum total bilirubin >3.1 mg/dL).

Table 1

Baseline Characteristics of the Study Population

IQR, Inter-quartile range; IV, intravenous; HBV, Hepatitis B virus; HCV, Hepatitis C virus

Table 2

Factors for Atazanavir Discontinuation due to Jaundice during a 12-month Period Among HIV-infected Koreans Receiving an Atazanavir-containing Regimen

OR, odds ratio; aOR, adjusted odds ratio; HBsAg, hepatitis B virus surface antigen; HCV Ab, antibody for hepatitis C virus; ART, anti-retroviral therapy

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