Contraception for the HIV-Positive Woman: A Review of Interactions between Hormonal Contraception and Antiretroviral Therapy

Abstract

Background. Preventing unintended pregnancy in HIV-positive women can significantly reduce maternal-to-child HIV transmission as well as improve the woman's overall health. Hormonal contraceptives are safe and effective means to avoid unintended pregnancy, but there is concern that coadministration of antiretroviral drugs may alter contraceptive efficacy. Materials and Methods. We performed a literature search of PubMed and Ovid databases of articles published between January 1980 and February 2012 to identify English-language reports of drug-drug interactions between hormonal contraceptives (HCs) and antiretroviral drugs (ARVs). We also reviewed the FDA prescribing information of contraceptive hormone preparations and antiretrovirals for additional data and recommendations. Results. Twenty peer-reviewed publications and 42 pharmaceutical package labels were reviewed. Several studies of combined oral contraceptive pills (COCs) identified decreased serum estrogen and progestin levels when coadministered with certain ARVs. The contraceptive efficacy of injectable depot medroxyprogesterone acetate (DMPA) and the levonorgestrel intrauterine system (LNG-IUS) were largely unaffected by ARVs, while data on the contraceptive patch, ring, and implant were lacking. Conclusions. HIV-positive women should be offered a full range of hormonal contraceptive options, with conscientious counseling about possible reduced efficacy of COCs and the contraceptive implant when taken with ARVs. DMPA and the LNG-IUS maintain their contraceptive efficacy when taken with ARVs.

Optimizing antiretroviral therapy for women living with HIV

“…Antiretroviral drugs such as ritonavir and the nonnucleoside reverse transcriptase inhibitors (NNRTIs) induce cytochromes and therefore increase the metabolism of hormonal contraceptives. Thus, the effectiveness of the combined oral contraceptive (COC) pill is likely to be reduced by protease inhibitors and NNRTIs [42]. However, the second-generation NNRTIs, including etravarine and rilpivirine, do not appear to alter the effectiveness of the COC and can be coadministered [43,44].…”

Women living with HIV still lack highly effective contraception: results from the ANRS VESPA2 study, France, 2011

“…In the early highly active antiretroviral therapy period, possible drug interactions between antiretroviral drugs and hormonal contraception led to cautious recommendations with regard to their concurrent use in women. However, as further evidence of such interactions was not found [3], the World Health Organization (WHO) concluded in 2012 that women living with HIV could use hormonal contraception without restriction, including intrauterine devices (IUDs; copper IUD or hormone-releasing IUD) [4,5].…”

Fertility-related research needs among women at the margins

“…10 There has been substantial evidence assessing contraceptive use and unmet family planning needs of women living with HIV, 11 including the impact of antiretrovirals on the efficacy of hormonal contraceptives. 12 Yet, gaps exist in the understanding of knowledge and use of emergency contraception among women living with HIV, as well as to what extent certain antiretroviral drugs may reduce the efficacy of emergency contraception. 13,14 Recently, much attention has been given to the impact of hormonal contraception on HIV disease progression and HIV transmission and acquisition, though evidence of the impact on transmission and acquisition remains inconclusive.…”