Moreover, certain antiretroviral drugs also precipitate acute porphyria, such as atazanavir and ritonavir, which inhibit CYP-3A4, leading to heme depletion in hepatocytes, leading to compensatory activation of heme synthesis and toxic accumulation of ALA and PBG precursors in patients who are carriers of acute porphyria genetic mutations [36]. Here, CYP3A4 is linked to hepatic porphyria.