Levonorgestrel concentrations during 7 years of continuous use of Jadelle contraceptive implants☆

Sivin, Irving; Wan, Livia; Ranta, Susanna; Alvarez, Francisco; Brache, Vivian; Mishell, Daniel R.; Darney, Philip D.; Biswas, Arijit; Dı́az, Soledad; Kiriwat, Orawan; Anant, Manee Piya; Klaisle, Cynthia; Pavéz, Margarita; Schechter, Janet

doi:10.1016/s0010-7824(01)00226-8

Cited by 73 publications

(54 citation statements)

References 6 publications

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“…There have been several contraceptive implants utilized globally, including Jadelle, Implanon, Nexplanon, Norplant and Sino-implant. Jadelle, a 2 rod-implant, with each rod containing 75 mg of levonorgestrel (LNG), is the most commonly used in Africa with an efficacy for up to 5, and possibly 7, years [67] following insertion. Given the increasing acceptance of LNG implant use in regions with high HIV prevalence [68], its high efficacy in preventing unintended pregnancy, and its longer duration of action, we chose to use the Jadelle LNG implant as the comparison method in this study.…”

Section: Rationale For the Studymentioning

confidence: 99%

A randomized clinical trial on the effects of progestin contraception in the genital tract of HIV-infected and uninfected women in Lilongwe, Malawi: Addressing evolving research priorities

Kourtis

Haddad

Tang³

et al. 2017

Contemporary Clinical Trials

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Hormonal contraception is central in the prevention of unintended pregnancy; however there are concerns that certain methods may increase the risk of HIV acquisition and transmission. Hormonal contraceptives may modify the genital mucosa in several ways, however the mechanisms are incompletely understood. Few studies have examined genital HIV shedding prospectively before and after initiation of hormonal contraception. The effects of hormonal contraception on genital HIV shedding in the setting of antiretroviral therapy (ART) are also unknown. We designed a pilot clinical trial in which HIV-infected and uninfected women were randomized to either depot medroxyprogesterone acetate (DMPA) injectable or levonorgestrel (LNG) implant in Lilongwe, Malawi. The objectives were to: 1) assess the effect and compare the impact of type of progestin contraception (injectable versus implant) on HIV genital shedding among HIV-infected women, 2) assess the effect and compare the impact of type of progestin contraception on inflammatory/immune markers in the genital tract of both HIV-infected and uninfected women, and 3) assess the interaction of progestin contraception and ART by examining contraceptive efficacy and ART efficacy. An additional study aim was to determine the feasibility and need for a larger study of determinants of HIV transmissibility and acquisition. As injectable contraception is widely used in many parts of the world with high HIV prevalence, this study will provide important information in determining the need for and feasibility of a larger study to address these questions that can impact the lives of millions of women living with or at risk for HIV.

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Section: Rationale For the Studymentioning

confidence: 99%

A randomized clinical trial on the effects of progestin contraception in the genital tract of HIV-infected and uninfected women in Lilongwe, Malawi: Addressing evolving research priorities

Kourtis

Haddad

Tang³

et al. 2017

Contemporary Clinical Trials

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“…In addition, few studies are available regarding whether implants containing levonorgestrel or etonogestrel have different contraceptive effectiveness when used with efavirenz. Furthermore, with both implants, it is possible that interactions with enzyme inducers such as efavirenz are time-dependent, because hormone levels decrease over time after implantation [71]. Other data gaps are whether injectable contraceptives other than intramuscular DMPA, such as the lower-dose subcutaneous DMPA or injectable norethisterone enanthate, might be susceptible to drug interactions.…”

Section: Discussionmentioning

confidence: 99%

Drug interactions between hormonal contraceptives and antiretrovirals

Nanda

Stuart

Robinson³

et al. 2017

Aids

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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.

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“…Considering total body water content of 35.5 litres (71 kg and 50% lean body weight) and an equal distribution, it would render 422–563 pg/ml of levonorgestrel. The minimum levonorgestrel concentration needed to protect against pregnancy is below 200 pg/ml and possibly below 175 pg/ml 3 15. Therefore, in theory, one functional rod could still be preventing pregnancy.…”

Section: Discussionmentioning

confidence: 99%