Bilirubin Elevation in HIV Patients

Mechanism and Contributing Factors

• Paritaprevir inhibits bilirubin transporters OATP1B1 and OATP1B3, causing transient increases in indirect bilirubin in patients with HCV/HIV coinfection, with a greater frequency of total bilirubin increases observed in patients with cirrhosis 1, 2, 3

Clinical Management and Monitoring

• The American Association for the Study of Liver Diseases recommends monitoring liver function tests regularly when starting medications known to affect bilirubin, such as paritaprevir, in patients with HCV/HIV coinfection 3
• The European Association for the Study of the Liver notes that distinguish protease inhibitor-induced hyperbilirubinemia from other causes, it manifests as isolated unconjugated hyperbilirubinemia without ALT elevations 3