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Although this may indicate a serious disorder of liver function, this is not always the case. An understanding of bilirubin formation, metabolism, and transport can provide a helpful approach to dealing with these patients. This is typified by studies of patients treated with the antiretroviral drug atazanavir. Atazanavir has been associated with hyperbilirubinemia in as many as one\u2010third of individuals for whom it has been prescribed, evoking concerns of hepatotoxicity. The studies in this report were designed to determine mechanisms by which this occurs. The data show that this drug inhibits the enzyme UDP\u2010glucuronosyl transferase\u20101A1, responsible for conjugating bilirubin with glucuronic acid. This conjugation step is required for bilirubin excretion into bile, and when it is inhibited, bilirubin refluxes from the liver into the circulation, causing unconjugated hyperbilirubinemia. Other parameters of bilirubin formation, binding to albumin in the circulation, uptake into hepatocytes, and intracellular protein binding in hepatocytes were unaffected by atazanavir. The effect of atazanavir on serum bilirubin levels is reversible, consistent with lack of structural damage to the liver.<\/jats:p>","DOI":"10.1002\/cpdd.314","type":"journal-article","created":{"date-parts":[[2017,3,6]],"date-time":"2017-03-06T15:25:23Z","timestamp":1488813923000},"page":"140-146","source":"Crossref","is-referenced-by-count":15,"title":["Drug\u2010 and Drug Abuse\u2013Associated Hyperbilirubinemia: Experience With Atazanavir"],"prefix":"10.1002","volume":"6","author":[{"given":"Jayanta","family":"Roy\u2010Chowdhury","sequence":"first","affiliation":[{"name":"Marion Bessin Liver Research Center Albert Einstein College of Medicine and Montefiore Medical Center  Bronx NY USA"},{"name":"Division of Gastroenterology and Liver Diseases Albert Einstein College of Medicine and Montefiore Medical Center  Bronx NY USA"},{"name":"Department of Genetics Albert Einstein College of Medicine and Montefiore Medical Center  Bronx NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Namita","family":"Roy\u2010Chowdhury","sequence":"additional","affiliation":[{"name":"Marion Bessin Liver Research Center Albert Einstein College of Medicine and Montefiore Medical Center  Bronx NY USA"},{"name":"Division of Gastroenterology and Liver Diseases Albert Einstein College of Medicine and Montefiore Medical Center  Bronx NY USA"},{"name":"Department of Genetics Albert Einstein College of Medicine and Montefiore Medical Center  Bronx NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irving","family":"Listowsky","sequence":"additional","affiliation":[{"name":"Marion Bessin Liver Research Center Albert Einstein College of Medicine and Montefiore Medical Center  Bronx NY USA"},{"name":"Department of Biochemistry Albert Einstein College of Medicine and Montefiore Medical Center  Bronx NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allan W.","family":"Wolkoff","sequence":"additional","affiliation":[{"name":"Marion Bessin Liver Research Center Albert Einstein College of Medicine and Montefiore Medical Center  Bronx NY USA"},{"name":"Division of Gastroenterology and Liver Diseases Albert Einstein College of Medicine and Montefiore Medical Center  Bronx NY USA"},{"name":"Department of Anatomy and Structural Biology Albert Einstein College of Medicine and Montefiore Medical Center  Bronx NY USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2017,3,6]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-12-382026-6.00054-3"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-1-4377-0881-3.00062-0"},{"key":"e_1_2_7_4_1","first-page":"151","volume-title":"Schiff's Diseases of the Liver","author":"Wolkoff AW","year":"2012"},{"key":"e_1_2_7_5_1","unstructured":"O'MaraE MummaneniV BifanoM et\u00a0al.Pilot study of the interaction between BMS\u2010232632 and ritonavir. 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