Sorry, the correct answer is D. Transgender women may fear drug-drug interactions with their hormone therapy, which can cause them to discontinue or not take ART as prescribed. Discussing factors leading to non-adherence and providing reassurance about the lack of significant interactions between hormones and ART would be the next step. There are unlikely to be drug-drug interactions between this unboosted integrase regimen and either estradiol or spironolactone. Stopping or reducing the hormone regimen is not appropriate. Bictegravir is an unboosted integrase strand transfer inhibitor with a high barrier
Reference:
Cirrincione LR, Senneker T, Scarsi K, Tseng A. Drug Interactions with Gender-Affirming Hormone Therapy: Focus on Antiretrovirals and Direct Acting Antivirals [published correction appears in Expert Opin Drug Metab Toxicol. 2021 Jan 1;:1]. Expert Opin Drug Metab Toxicol. 2020;16(7):565-582. doi:10.1080/17425255.2020.1777278
Braun HM, Candelario J, Hanlon CL, et al. Transgender Women Living with HIV Frequently Take Antiretroviral Therapy and/or Feminizing Hormone Therapy Differently Than Prescribed Due to Drug-Drug Interaction Concerns. LGBT Health. 2017;4(5):371-375. doi:10.1089/lgbt.2017.0057