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Through its inhibitory effect on bilirubin UDP-glucoronyltransferase (UGT) enzymatic activity, the protease inhibitor atazanavir increases unconjugated bilirubin levels. In a recent study, researchers in Canada assessed the incidence and outcomes of hyperbilirubinemia among 1150 HIV-infected patients followed up in a large clinical cohort between 2003 (the year atazanavir was approved) and 2012. Patients who had taken atazanavir for at least 3 months were considered to be atazanavir-exposed. The researchers looked in particular at grades 3 and 4 levels of hyperbilirubinemia (equal to >2.5 and >5 times the upper limit of normal, respectively).
Cumulative incidence of any grade 3 or 4 hyperbilirubinemia was markedly higher among atazanavir-exp…