Atazanavir is a long established protease inhibitor used in HIV treatment. It is given alongside a booster and is well known for one distinctive and generally harmless effect. This guide explains what atazanavir is, how it works, where it fits in treatment today, and the points a treating doctor keeps under review.
Atazanavir is often abbreviated to ATV, and is usually written together with its booster, for example atazanavir/ritonavir.
| Important note This article is general information about medicines used in HIV care. It does not include dosing instructions and is not a substitute for medical advice. All HIV medicines are prescription-only and are selected, started, and changed by a qualified doctor. |
Quick Summary / Key Takeaways
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Atazanavir is a long established protease inhibitor used in HIV treatment. It is given alongside a booster and is well known for one distinctive and generally harmless effect. Atazanavir is often abbreviated to ATV.
Atazanavir belongs to the protease inhibitor class described in the guide to protease inhibitors. It acts at the final stage of the viral life cycle and is used alongside other antiretroviral medicines, usually with a booster.
HIV uses an enzyme called protease to cut long protein chains into the pieces needed to build new, infectious particles. Atazanavir blocks that enzyme, so although new particles are still produced, they cannot mature into a form capable of infecting other cells.
Atazanavir is well known for causing a yellowing of the skin or the whites of the eyes in some people. This happens because atazanavir can raise the level of a substance called bilirubin. In this situation the effect is generally harmless and does not reflect harm to the liver, although it should always be reviewed by the treating doctor so the cause can be confirmed.
Atazanavir is a long established option used mainly when a regimen is being changed rather than for people starting treatment, where integrase inhibitor regimens are preferred. Current guidance now names darunavir with ritonavir as the preferred protease inhibitor, covered in the guide to darunavir, with atazanavir remaining an established alternative. Its place in subsequent treatment is discussed in second-line ART and when to switch.
| Effect | What is generally observed |
|---|---|
| Yellowing of skin or eyes | Reflects a rise in bilirubin, generally harmless, and reviewed by the doctor |
| Nausea or digestive effects | Usually mild and often settling |
| Headache | Reported and usually mild |
| Changes in lipid measures | Monitored at routine follow-up |
| Skin rash | Usually mild and early; persistent rash needs review |
| Myth | Fact |
|---|---|
| Yellowing of the eyes always signals a serious problem. | With atazanavir it usually reflects a harmless rise in bilirubin, but needs review. |
| Atazanavir is taken without a booster. | It is usually given with a booster such as ritonavir. |
| The booster is the main treatment medicine. | The booster raises atazanavir levels; atazanavir is the active treatment. |
| Atazanavir is a first-line medicine for everyone. | It is mainly used when a regimen is being changed. |
| Acidity medicines make no difference. | Medicines that reduce stomach acid can affect atazanavir and are reviewed by the doctor. |
| When to Consult a Doctor Medical advice is appropriate before starting or changing atazanavir, where yellowing of the skin or eyes appears, where digestive effects persist, and whenever another medicine including one for acidity is being started. A consultation can be arranged through an HIV doctor consultation. |
Atazanavir blocks the enzyme HIV needs to assemble mature, infectious particles, and is usually given with a booster. Its best known effect, a generally harmless yellowing of the skin or eyes, reflects a rise in bilirubin rather than liver harm. It remains an established option used mainly when treatment is being changed, under the direction of a treating doctor.
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Atazanavir is a protease inhibitor used as part of combination HIV treatment. It is a long established option used mainly when a regimen is being changed.
It blocks protease, the enzyme HIV uses to cut protein chains into the pieces needed to build new infectious particles. New particles are still produced but cannot mature.
Atazanavir can raise the level of a substance called bilirubin, which causes yellowing of the skin or the whites of the eyes in some people. In this situation the effect is generally harmless.
It usually reflects a harmless rise in bilirubin rather than harm to the liver. It should still be reviewed by the treating doctor so the cause can be confirmed.
A booster such as ritonavir slows how quickly atazanavir is cleared from the body, so it remains at effective levels. When used this way the booster is not the main treatment medicine.
Yes. Medicines that reduce stomach acid can affect how atazanavir is absorbed, so the treating doctor reviews these and advises on timing or alternatives.
Yes, atazanavir remains an established option. Current guidance now names darunavir with ritonavir as the preferred protease inhibitor, with atazanavir used where the treating doctor considers it suitable.
No. It is used as part of a combination regimen and is usually given together with a booster.
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