Gilbert syndrome and the development of antiretroviral therapy-associated hyperbilirubinemia

Margalida Rotger, Patrick Taffé, Gabriela Bleiber, Huldrych F. Günthard, Hansjakob Furrer, Pietro Vernazza, Henning Drechsler, Enos Bernasconi, Martin Rickenbach, Amalio Telenti

Research output: Contribution to journalArticlepeer-review

178 Scopus citations


Background. Unconjugated hyperbilirubinemia results from Gilbert syndrome and from antiretroviral therapy (ART) containing protease inhibitors. An understanding of the interaction between genetic predisposition and ART may help to identify individuals at highest risk for developing jaundice. Methods. We quantified the contribution of UGT1A1*28 and ART to hyperbilirubinemia by longitudinally modeling 1386 total bilirubin levels in 96 human immunodeficiency virus (HIV)-infected individuals during a median of 6 years. Results. The estimated average bilirubin level was 8.8 μmol/L (0.51 mg/dL). Atazanavir increased bilirubin levels by 15 μmol/L (0.87 mg/dL), and indinavir increased bilirubin levels by 8 μmol/L (0.46 mg/dL). Ritonavir, lopinavir, saquinavir, and nelfinavir had no or minimal effect on bilirubin levels. Homozygous UGT1A1*28 increased bilirubin levels by 5.2 μmol/L (0.3 mg/dL). As a consequence, 67% of individuals homozygous for UGT1A1*28 and receiving atazanavir or indinavir had ≥2 episodes of hyperbilirubinemia in the jaundice range (>43 μmol/L [>2.5 mg/dL]), versus 7% of those with the common allele and not receiving either of those protease inhibitors (P < .001). Efavirenz resulted in decreased bilirubin levels, which is consistent with the induction of UDP-glucuronosyltransferase 1A1. Conclusions. Genotyping for UGT1A1*28 before initiation of ART would identify HIV-infected individuals at risk for hyperbilirubinemia and decrease episodes of jaundice.

Original languageEnglish (US)
Pages (from-to)1381-1386
Number of pages6
JournalJournal of Infectious Diseases
Issue number8
StatePublished - Oct 15 2005

ASJC Scopus subject areas

  • Immunology and Allergy
  • Infectious Diseases


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