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Updated: Jan 24, 2026

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Association Between Bilirubin, Atazanavir, and Cardiovascular Disease Events Among People Living With HIV Across the

Heidi M Crane1, Robin M Nance1, Susan R Heckbert1

  • 1Department of Medicine, University of Washington, Seattle, WA.

Journal of Acquired Immune Deficiency Syndromes (1999)
|May 29, 2019
PubMed

Insights

Higher bilirubin levels are linked to type 2 myocardial infarctions (T2MI) in people living with HIV (PLWH). However, a protective effect was observed for T2MI and combined T1MI/stroke in PLWH taking atazanavir.

Area of Science:

  • Cardiovascular Science
  • HIV Medicine
  • Biochemistry

Background:

  • Bilirubin, an antioxidant, may inhibit lipid oxidation.
  • Elevated bilirubin is linked to fewer cardiovascular events in HIV-uninfected individuals.
  • The association between bilirubin and cardiovascular events in people living with HIV (PLWH) requires examination.

Purpose of the Study:

  • To investigate the association between total bilirubin levels and cardiovascular events in PLWH.
  • To differentiate between type 1 myocardial infarction (T1MI) and type 2 myocardial infarction (T2MI) in relation to bilirubin levels.
  • To explore potential modifying effects of atazanavir use and hepatitis C status.

Main Methods:

  • Multivariable Cox regression analyses were used to assess associations.
  • Outcomes included centrally adjudicated T1MI and T2MI.
  • Analyses were adjusted for traditional and HIV-specific risk factors, with subgroup analyses to minimize confounding.

Main Results:

  • Higher bilirubin levels were associated with T2MI in the overall PLWH cohort.
  • No significant association was found between higher bilirubin levels and T1MI.
  • Among PLWH on atazanavir, higher bilirubin levels were associated with fewer T2MI and fewer combined T1MI/ischemic strokes.

Conclusions:

  • Elevated bilirubin shows differential associations with cardiovascular outcomes in PLWH, varying by the cause of the event.
  • A protective association between bilirubin and T2MI was observed in PLWH using atazanavir.
  • Distinguishing between MI types is crucial for understanding bilirubin's role in cardiovascular health among PLWH.
Abstract

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