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Adverse Effects of Antiretroviral MedicationsQuestion 3/10

A 37-year-old man with HIV and a CD4 count of 574 cells/mm3 has taken atazanavir-cobicistat and tenofovir DF-emtricitabine for about 6 years. Laboratory studies 6 months ago showed a total bilirubin level of 2.5 mg/dL. At a current clinic visit, scleral icterus is noted on physical examination and laboratory studies show a total bilirubin level of 3.8 mg/dL. He states that he feels well and has no other symptoms.

Which one of the following is the most likely cause of his jaundice?

Atazanavir can increase serum total bilirubin through inhibition of the liver enzyme uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1); this enzyme is a key enzyme in the normal glucuronidation of bilirubin.<br /> Abbreviation: UGT1A1 = uridine diphosphate glucuronosyltransferase 1A1
Figure 1. Atazanavir and Inhibition of the UGT1A1 Enzyme.
Atazanavir can increase serum total bilirubin through inhibition of the liver enzyme uridine diphosphate glucuronosyltransferase 1A1 (UGT1A1); this enzyme is a key enzyme in the normal glucuronidation of bilirubin.
Abbreviation: UGT1A1 = uridine diphosphate glucuronosyltransferase 1A1
Illustration: David H. Spach, MD
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Question Last Updated
January 28th, 2025

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