Abstract
New Direct-acting Antiviral Agents (DAA)-based anti-HCV therapies currently provide extraordinary opportunities to cure patients. Drug-drug interactions are however a real challenge during treatment. In particular, in HIV-infected patients in cART, DAA choice is limited by such interactions, which can result both in reduced efficacy and toxicity. We report the case of a HIV-infected patient on cART with atazanavir/ritonavir/abacavir/lamivudine, who presented kidney and biliary lithiasis, the latter treated with endoscopic retrograde cholangiopancreatography and endoscopic biliary sphincterotomy, after beginning anti-HCV treatment with daclatasvir/sofosbuvir/ribavirin. Hyperbilirubinemia with or without jaundice is a well known side effect of atazanavir, because of its inhibition of uridine diphosphate-glucuronosyl transferase. We speculate that in this case hyperbilirubinemia worsening was due to atazanavir/ribavirin co-administration. However, pharmacokinetic data are lacking about atazanavir/daclatasvir concomitant administration in real life setting.
MeSH terms
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Adult
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Anti-HIV Agents / administration & dosage*
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Anti-HIV Agents / adverse effects
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Antiviral Agents / administration & dosage*
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Antiviral Agents / adverse effects
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Atazanavir Sulfate / administration & dosage
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Biliary Tract Diseases / chemically induced
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Biliary Tract Diseases / pathology
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Biliary Tract Diseases / therapy
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Carbamates
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Coinfection
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Dideoxynucleosides / administration & dosage
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Drug Combinations
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Drug Interactions
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Genotype
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HIV Infections / complications
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HIV Infections / drug therapy
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Hepacivirus / genetics
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Hepacivirus / isolation & purification
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Hepatitis C / complications
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Hepatitis C / drug therapy
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Humans
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Imidazoles / administration & dosage
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Kidney Calculi / chemically induced
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Kidney Calculi / pathology
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Kidney Calculi / therapy
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Lamivudine / administration & dosage
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Lithiasis / chemically induced*
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Lithiasis / pathology
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Lithiasis / therapy
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Male
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Pyrrolidines
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Ribavirin / administration & dosage
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Ritonavir / administration & dosage
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Sofosbuvir / administration & dosage
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Valine / analogs & derivatives
Substances
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Anti-HIV Agents
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Antiviral Agents
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Carbamates
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Dideoxynucleosides
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Drug Combinations
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Imidazoles
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Pyrrolidines
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abacavir, lamivudine drug combination
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Lamivudine
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Ribavirin
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Atazanavir Sulfate
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Valine
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daclatasvir
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Ritonavir
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Sofosbuvir