Drug interactions between hormonal contraceptives and antiretrovirals

Abstract

Objective:To summarize published evidence on drug interactions between hormonal contraceptives and antiretrovirals.Design:Systematic review of the published literature.Methods:We searched PubMed, POPLINE, and EMBASE for peer-reviewed publications of studies (in any language) from inception to 21 September 2015. We included studies of women using hormonal contraceptives and antiretrovirals concurrently. Outcomes of interest were effectiveness of either therapy, toxicity, or pharmacokinetics. We used standard abstraction forms to summarize and assess strengths and weaknesses.Results:Fifty reports from 46 studies were included. Most antiretrovirals whether used for therapy or prevention, have limited interactions with hormonal contraceptive methods, with the exception of efavirenz. Although depot medroxyprogesterone acetate is not affected, limited data on implants and combined oral contraceptive pills suggest that efavirenz-containing combination antiretroviral therapy may compromise contraceptive effectiveness of these methods. However, implants remain very effective despite such drug interactions. Antiretroviral plasma concentrations and effectiveness are generally not affected by hormonal contraceptives.Conclusion:Women taking antiretrovirals, for treatment or prevention, should not be denied access to the full range of hormonal contraceptive options, but should be counseled on the expected rates of unplanned pregnancy associated with all contraceptive methods, in order to make their own informed choices.

Transgender Women Living with HIV Frequently Take Antiretroviral Therapy and/or Feminizing Hormone Therapy Differently Than Prescribed Due to Drug–Drug Interaction Concerns

“…21 A recent systematic review found that the most noteworthy interactions occurred for cisgender women using NNRTIs, and particularly efavirenz, although these outcomes were predominantly pharmacokinetic in nature and assessed interactions at doses used for contraception rather than feminizing HT. 22 No studies have specifically addressed interactions between ART and the estrogen regimens/doses used for feminizing HT. Thus, there are insufficient data to fully understand the risk of DDIs between ART and HT for TW.…”

Strengthening implant provision and acceptance in South Africa with the ‘Any woman, any place, any time’ approach: An essential step towards reducing unintended pregnancies

“…[73] There are substantial drug interactions between efavirenz and Implanon, considerably reducing drug levels of etonogestrel, the active drug in Implanon. [74][75][76] Interactions between efavirenz and Jadelle appear even more pronounced than with Implanon. [77,78] Women using an implant, who are also taking efavirenz, have higher pregnancy rates than those taking other antiretrovirals.…”

“…Available data therefore do not support limiting access to the implant in women taking efavirenz. [75] Moreover, the use of efavirenz is likely to be phased out over time, alleviating many of these concerns.…”

Current and future contraceptive options for women living with HIV

“…Generally, NRTIs and INSTIs are not considered significant inhibitors, inducers, or substrates of CYP450 enzymes, and, therefore, unlikely to influence hormonal contraceptive exposure [14,15]. Two recent systematic reviews on DDIs between hormonal contraceptives and antiretrovirals for women living with HIV thoroughly cover the aforementioned aspects [15,16]. In Section 3, we highlight pertinent findings for each combination of contraceptive method and antiretroviral classes.…”