title: Severe Hyperbilirubinemia in an HIV-HCV-Coinfected Patient Starting the 3D Regimen That Resolved After TDM-Guided Atazanavir Dose Reduction.
abstract: The combination of ombitasvir, dasabuvir, and paritaprevir/ritonavir (considered as the 3D regimen) has proven to be associated with high sustained virologic response and optimal tolerability in hepatitis C virus-infected patients. Here, we describe an HIV-HCV-coinfected patient who experienced a grade 4 hyperbilirubinemia and a 2.5-fold increase in the atazanavir plasma trough concentrations few days after the start of 3D-based antiviral therapy who benefited from an atazanavir dose reduction guided by therapeutic drug monitoring.
authors.affiliation: *Unit of Clinical Pharmacology; †Department of Infectious Diseases; ‡Clinical Pharmacology Unit, CNR Institute of Neuroscience, Department of Biomedical and Clinical Sciences, L. Sacco University Hospital, Università di Milano, Milan; and §Scientific Institute IRCCS E. Medea, Bosisio Parini, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Cattaneo
authors.forename: Agostino
authors.initials: A
authors.lastname: Riva
authors.forename: Emilio
authors.initials: E
authors.lastname: Clementi
authors.forename: Laura
authors.initials: L
authors.lastname: Milazzo
authors.forename: Cristina
authors.initials: C
authors.lastname: Gervasoni
mesh_terms: D015081:2-Naphthylamine; D000813:Anilides / Q000008:administration & dosage; D000998:Antiviral Agents / Q000008:administration & dosage* / Q000009:adverse effects; D000069446:Atazanavir Sulfate / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics; D002219:Carbamates / Q000008:administration & dosage; D060085:Coinfection; D003521:Cyclopropanes; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D016903:Drug Monitoring / Q000379:methods; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D006526:Hepatitis C / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D006932:Hyperbilirubinemia / Q000139:chemically induced*; D047029:Lactams, Macrocyclic; D047028:Macrocyclic Compounds / Q000008:administration & dosage; D008875:Middle Aged; D011392:Proline / Q000031:analogs & derivatives; D019438:Ritonavir / Q000008:administration & dosage; D013449:Sulfonamides / Q000008:administration & dosage; D014498:Uracil / Q000008:administration & dosage / Q000031:analogs & derivatives; D014633:Valine
chemical_list: D000813:Anilides; D000998:Antiviral Agents; D002219:Carbamates; D003521:Cyclopropanes; D017320:HIV Protease Inhibitors; D047029:Lactams, Macrocyclic; D047028:Macrocyclic Compounds; D013449:Sulfonamides; C586094:ombitasvir; D000069446:Atazanavir Sulfate; D014498:Uracil; D011392:Proline; D015081:2-Naphthylamine; C588260:dasabuvir; D014633:Valine; D019438:Ritonavir; C585405:paritaprevir