Question | Discussion | References | CME Credit

Case 6: Protease Inhibitor-Associated Hyperbilirubinemia

You answered:

C Atazanavir causes hyperbilirubinemia via competitive inhibition of a key enzyme involved in bilirubin conjugation; patients with Gilbert’s syndrome are more likely to develop jaundice and severe hyperbilirubinemia when exposed to atazanavir or indinavir than those who do not have Gilbert’s syndrome.

This answer is correct. The enhanced effect of atazanavir in persons with Gilbert’s syndrome occurs because patients with Gilbert’s syndrome have decreased production of the same hepatic enzyme that is inhibited by atazanavir; this enzyme plays a critical role in conjugating bilirubin.

[Back to Case 6 Question | Proceed to Case 6 Discussion]