Grand Rounds

Hyperbilirubinemia in a child on anti-retroviral therapy

Pawan Daga1, Ira Shah2
1Final year MBBS, Department of Paediatrics, Seth G S Medical College, Mumbai, 2Consultant in Pediatric Infectious Diseases, Levioza Health Care, Mumbai, India

Address for Correspondence: Pawan Daga, Seth G S Medical College, Parel, Mumbai, India 400012. Email:

Clinical Problem:
A 20 years old HIV infected girl on anti-retroviral therapy (ART) since the age of 12 years presented with jaundice for 3 months. There was no fever. She was initially on stavudine (d4T), lamivudine (3TC) and efavirenz (EFV) till the age of 17 years and was subsequently shifted to abacavir (ABC), lamivudine (3TC) and lopinavir/ritonavir (LPV/r) in view of virological failure. In view of high pill burden and undetectable viral load, LPV/r was omitted and Atazanavir/ritonavir (ATZ/r) (300/100mg) was started 3 months ago and ABC and 3TC were continued. Subsequently, the girl developed jaundice. Her total bilirubin 3 months ago was 3.8 mg/dL with direct bilirubin of 1.98 mg/dL. Currently her total bilirubin was 2.8 mg/dL with direct bilirubin of 0.78 mg/dL. Her liver transaminases, serum lactate and lipid levels were normal. Hepatitis B and Hepatitis C Elisa was negative.

What is the cause of the jaundice and how to manage the jaundice?

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