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Case 4: Antiretrovirals and Oral Contraceptives

You answered:

C Darunavir (Prezista) boosted with ritonavir (Norvir) will significantly increase ethinyl estradiol and norethindrone levels.

This answer is incorrect. Although it might be expected that ritonavir-boosted darunavir would increase ethinyl estradiol and norethindrone levels, the opposite occurs: available data show that ritonavir-boosed darunavir lowers ethinyl estradiol levels by more than 40%. In addition, levels of norethindrone are slightly lowered by ritonavir-boosted darunavir.

A Efavirenz (Sustiva) will likely reduce the efficacy of the oral contraceptive pill.
B Raltegravir (Isentress) will markedly lower ethinyl estradiol and norethindrone levels.
D Lopinavir-ritonavir (Kaletra) will not impact ethinyl estradiol and norethindrone levels.

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