Table 4.

Drug interactions between hormonal contraception and various antiretroviral agents.^a

Antiretroviral agent	Effect on drug concentration	Recommended action
Protease inhibitors (PI)
Atazanavir (ATV)	↑ EE AUC 48% ↑ NE AUC 110%	OK for use OCP should contain ≤ 30mcg EE. Monitor for side effects, or use alternative method
Atazanavir/ritonavir (ATV/r)	↓ EE ↑ norgestimate (active metabolite of NG)	OK for use OCP should contain ≥35mcg EE
Darunavir (DRV), Darunavir/ritonavir (DRV/r)	↓ EE AUC 44% ↓ NE AUC 14%	Do not use
Fosamprenavir (FPV)	With amprenavir: ↑ EE, ↑ NE ↓ amprenavir Cmin 20%	Do not use
Fosamprenavir/ritonavir (FPV/r)	↓ EE AUC 37% ↓ NE AUC 34%	Do not use
Lopinavir/ritonavir (LPV/r)	↓ EE AUC 42% ↓ NE AUC 17%	Do not use
Nelinavir (NFV)	↓ EE AUC 47% ↓ NE AUC 18%	Do not use
Saquinavir/ritonavir (SQV/r)	↓ EE SQV kinetics not affected by OCP	Do not use
Tipranavir/ritonavir (TPV/r)	↓ EE AUC 48% NE: no significant change	Do not use
Nonnucleoside reverse transcriptase inhibitors (NNRTI)
Efavirenz (EFV)	↓ NG AUC 64% ↓ LN AUC 83% EE: no effect	Do not use
Etravirine (ETR)	↑ EE AUC 22% NE: No significant change	OK for use
Nevirapine (NVP)	↓ EE AUC 20% ↓ NE AUC 19%	Do not use
Rilpivirine (RPV)	↑ EE AUC 14% NE: no significant change	OK for use
Integrase inhibitor
Raltegravir (RAL)	No significant interaction	OK for use
Elvitegravir (ELV)b	↓ EE AUC 25%	OK for use OCP should contain ≤ 30mcg EE. Await more data
CCR5 antagonist
Maraviroc (MRV)	No significant interaction	OK for use

AUC, area under the time concentration curve (drug exposure); C^min, minimum concentration; EE, ethinyl estradiol; LN, levonorgestrel; NE, norethindrone; NG, norgestimate; OCP, oral contraceptive pill.

^aAdapted from DHHS (2011a), DHHS (2011b), DHHS (2012).

^bWhen taken as a elvitegravir/cobicistat/FTC/tenofovir fixed dose ‘quad’ formulation (German, Wang, Warren, & Kearney, 2011).