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Updated July 6, 2012

Case 4: Antiretrovirals and Oral Contraceptives

Author: Bradley W. Kosel, PharmD David H. Spach, MD

A 25-year-old female with a CD4 cell count of 168 cells/mm3 presents to clinic to 3 months after having a new diagnosis of HIV. Three weeks ago she was started on trimethoprim-sulfamethoxazole (Bactrim, Septra) and she is tolerating this well. She takes norethindrone/ethinyl estradiol (Ortho Novum 7/7/7 Triphasic) for birth control and admits that her boyfriend is unlikely to consistently use condoms. You are planning to start her on antiretroviral therapy, but are concerned about how the antiretroviral medications may interact with her birth control pills.

Which of the following is TRUE regarding a potential drug-drug interactions with antiretroviral medications and the oral contraceptive?

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