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 (referred 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 ATV plasma trough concentrations few days after the start of 3D-based antiviral therapy who benefited from an ATV dose reduction guided by therapeutic drug monitoring.