References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
Atazanavir (brand name Reyataz) is a protease inhibitor used to treat HIV. A common side effect is raised bilirubin — a yellow pigment produced when red blood cells break down. Around one in three people taking atazanavir develop hyperbilirubinaemia, and some notice yellowing of the eyes or skin (jaundice).
This is usually harmless and reversible, but it’s worth understanding what’s happening so you can make an informed decision with your HIV specialist.
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Atazanavir blocks an enzyme in the liver called UGT1A1, which normally processes bilirubin so the body can get rid of it. When UGT1A1 is blocked, unconjugated (indirect) bilirubin builds up in the blood. People with Gilbert’s syndrome, who already have reduced UGT1A1 activity, are more likely to develop visible jaundice on atazanavir.
Is It Dangerous?
On its own, raised bilirubin from atazanavir is not harmful to the liver. Unlike bilirubin rises from hepatitis or liver damage, this is not a sign of liver injury. Liver enzymes (ALT, AST) usually remain normal.
| Marker | Atazanavir-related | Liver injury |
|---|---|---|
| Total bilirubin | Raised | Raised |
| Unconjugated bilirubin | Raised | Variable |
| ALT / AST | Normal | Raised |
| Symptoms beyond jaundice | None | Fatigue, nausea, pain |
When to Speak to Your Doctor
Contact your HIV clinic promptly if you notice:
- Jaundice that bothers you cosmetically or socially
- Dark urine or pale stools
- Right-sided abdominal pain
- Nausea, vomiting or loss of appetite
- Unusual fatigue
These additional symptoms would suggest something other than the usual atazanavir effect and need investigating.
Alternatives if Jaundice Bothers You
If visible yellowing is distressing, your HIV team may consider switching you to a different protease inhibitor (such as darunavir) or a different class altogether. Modern integrase inhibitors like dolutegravir or bictegravir do not cause this side effect.
Read more: HIV and heart disease | What is HIV?
Frequently Asked Questions
Yes. Bilirubin levels typically return to normal within a few weeks of stopping or switching from atazanavir.
Does yellowing mean my liver is damaged?
No. Atazanavir-related jaundice happens because the drug blocks bilirubin processing, not because it damages liver cells. Liver enzymes stay normal in most people.
Yes, if you and your doctor are happy to. The yellowing is harmless. Many people continue treatment without issue.
Related reading
- Choosing the Right PrEP Drug: Truvada vs Descovy
- Dovato for HIV: A Two-Drug Regimen
- Triumeq for HIV: A Straightforward Guide
- Efavirenz for HIV: An Older NNRTI Still in Use
- Eviplera: How This Anti-HIV Drug Works
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
