Bleeding patterns of HIV-infected women using an etonogestrel-releasing contraceptive implant and efavirenz-based or lopinavir/ritonavir-based antiretroviral therapy

Abstract

The co-administration of EFV-based or LPV/r-based ART with the ENG implant affected the expected bleeding patterns during use of the implant, although unfavourable bleeding (frequent and prolonged) was not associated with the medications under evaluation.

A systematic review of contraceptive continuation among women living with HIV

“…The initial electronic search of the literature produced 939 citations, with an additional 44 identified from review articles; 45 citations were identical between different databases and these duplicates were removed ( Figure 1). Following screening of 107 full-text publications, 22 were determined to meet inclusion criteria from 18 studies, with four studies each producing two separate publications with results relevant to contraceptive continuation among WLHIV [39,40,[46][47][48][49][50][51]. Contraceptive continuation definitions varied between studies, with participant report used by 18.2% (4/22), directly provided by the study site by 54.5% (12/22), or a mixture based on selected method by 27.3% (6/22).…”

“…Contraceptive continuation definitions varied between studies, with participant report used by 18.2% (4/22), directly provided by the study site by 54.5% (12/22), or a mixture based on selected method by 27.3% (6/22). Table 1 describes studies with a comparison group (n=13) [39,40,[46][47][48][49][50][51][52][53][54][55][56][57][58][59][60]. Most of these studies (n=10) were conducted in sub-Saharan Africa [46][47][48][49][50][51][53][54][55][57][58][59][60], with the remaining studies each conducted in the United States [52], Brazil [49,50], and Thailand [56].…”

“…Most of these studies (n=10) were conducted in sub-Saharan Africa [46][47][48][49][50][51][53][54][55][57][58][59][60], with the remaining studies each conducted in the United States [52], Brazil [49,50], and Thailand [56]. Seven of these studies were randomized trials and five were cohort studies, of which four were secondary analyses with the primary outcome(s) unrelated to contraceptive continuation [40,46,47,52,55,56,60]. Studies without a comparison group (n=5) reported continuation of single methods and are summarized in Table 2 [61][62][63][64][65].…”

“…Among studies with comparison groups, four compared contraceptive use over time between women by HIV serostatus [52,53,58], and eight compared continuation of either different contraceptive methods [46][47][48][49][50][51]54,56,60], a different dosing route [59], or a single contraceptive method with different ART regimens [39,40] among WLHIV. Two studies reported the effects of behavioral interventions to increase contraceptive uptake and use in discordant and concordant couples [55,57].…”

“…It is possible WLHIV may face greater barriers to accessing a full range of contraceptive methods through providerand system-imposed barriers. Additionally, as concerns arise surrounding safety and efficacy of contraceptives in the presence of new ART regimens, [36][37][38][39][40] WLHIV and/or their healthcare providers may impose limitations on method choice in response. We sought to determine whether there are consistent differences in contraceptive continuation, both objectively measured and self-reported, between WLHIV and women who do not have HIV and whether differences are impacted by method type, ART use, or other factors.…”