Implanon<sup>®</sup> failure in an HIV-positive woman on antiretroviral therapy resulting in two ectopic pregnancies

McCarty, E J; Keane, Helen; Quinn, Katherine; Quah, SP

doi:10.1258/ijsa.2009.009469

Cited by 27 publications

(17 citation statements)

References 7 publications

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“…In another case report, a 34-year-old HIV-positive woman on a HAART regimen of zidovudine, lamivudine, and efavirenz was treated for a ruptured ectopic pregnancy 28 months after insertion of an etonogestrel contraceptive implant [29]. Interestingly, this patient did not have her Implanon removed and was treated for a subsequent ectopic pregnancy on the contralateral side nine months later (i.e., more than 3 years after initial placement of the implant).…”

Section: Resultsmentioning

confidence: 99%

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

Robinson

Jamshidi

Burke

2012

Infectious Diseases in Obstetrics and Gynecology

133

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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.

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Section: Resultsmentioning

confidence: 99%

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

Robinson

Jamshidi

Burke

2012

Infectious Diseases in Obstetrics and Gynecology

133

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“…The literature regarding EFV is more mixed. Studies have found no effect of EFV on progesterone levels when using DMPA [8,10,16], but significantly lower progesterone levels among implant users [17–19,15], along with contraceptive failure rates up to 15% among levonorgestrel implant users [20–22]. Evidence regarding EFV and OCs is very limited, suggesting lower progesterone levels but not necessarily increased ovulation on EFV [13,23,24].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of hormonal contraception in HIV-infected women using antiretroviral therapy

Pyra

Heffron

Mugo

et al. 2015

Aids

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Objective To assess whether antiretroviral therapy (ART) may diminish the effectiveness of hormonal contraceptive methods. Methods Using data from 5,153 HIV-infected women followed prospectively one to three years in three HIV prevention studies in Africa, we compared incident pregnancy rates by contraceptive method (implant, injectable, oral, or none) and ART use. Multivariable Cox regression models were used to determine adjusted hazard ratios (aHR) and test interactions between each method and ART use. Results During follow-up, 9% of women ever used implants, 40% used injectables, and 14% used oral contraceptives; 31% of women ever used ART, mostly nevirapine (75% of ART users) or efavirenz-based (15%). Among women not using contraception, pregnancy rates were 13.2 and 22.5 per 100 women-years for those on and not on ART, respectively. Implants greatly reduced the incidence of pregnancy among both women on ART (aHR 0.06, 95% CI 0.01-0.45) and not on ART (aHR 0.05, 95% CI 0.02-0.11). Injectables (aHR 0.18 on ART and aHR 0.20 not on ART) and oral contraceptives (aHR 0.37 on ART and aHR 0.36 not on ART) also reduced pregnancy risk, though by lesser degrees. ART use did not significantly diminish contraceptive effectiveness, although all methods showed non-statistically significant reduced effectiveness when concurrently using efavirenz. Conclusion Hormonal contraceptive methods are highly effective in reducing pregnancy risk in HIV-infected women, including those concurrently using ART. Studies of potential interactions between ART and contraceptives should evaluate real-world effectiveness of contraceptive methods; in this study, implants were the most effective method to prevent pregnancy, even during ART use.

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“…In terms of slow-release contraceptive products, a small study by Heikinheimo et al ., found that the levonorgestrel intrauterine device did not adversely affect women living with HIV or increase genital shedding of HIV [12]. Recently, case reports of contraceptive failure of an etonogestrel implant (while using efavirenz) have raised concerns over simultaneous use [13,14]. …”

Section: Discussionmentioning

confidence: 99%

Effect of concurrent use of anti‐retroviral therapy and levonorgestrel sub‐dermal implant for contraception on CD4 counts: a prospective cohort study in Kenya

Hubacher

Liku²,

Kiarie

et al. 2013

Journal of the International AIDS Society

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IntroductionSimultaneous use of contraceptive hormones and anti-retroviral therapy (ART) may theoretically lessen the effectiveness of both. Women on ART need assurance that hormonal contraception is safe and effective. The sub-dermal implant is an ideal product to study: low and steady progestin release and no adherence uncertainties. We sought to determine if the medications’ effectiveness is compromised.MethodsWe conducted a prospective cohort study among women on first line ART (stavudine or zidovudine and lamivudine+nevirapine). We recruited new implant users and matched them to women not using hormonal contraception, based on age and baseline CD4. Participants were followed prospectively for up to two years, recording serial CD4 measures and medical histories. We used generalized growth curve models and Wald chi-square tests to compare changes in CD4 counts across study groups. Prospective CD4 measures were censored (excluded) if any of the following events occurred: change in ART, implant removal or use of any hormonal contraception among controls. We examined incidence of opportunistic infection and pregnancy.ResultsWe matched 48 implant users to 33 non-hormonal controls. Over time, CD4 counts for both groups rose slightly but did not deviate significantly from each other (p=0.44). Opportunistic infection rates did not differ between the groups. None of the implant users and one of the non-hormonal controls became pregnant during follow-up.ConclusionsThis small study found concurrent use of contraceptive implants and ART to be safe and effective. Although other hormonal contraceptive products and ART regimens may interact in unknown ways, the results of this study are reassuring.

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Implanon^® failure in an HIV-positive woman on antiretroviral therapy resulting in two ectopic pregnancies

Cited by 27 publications

References 7 publications

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

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

Effectiveness of hormonal contraception in HIV-infected women using antiretroviral therapy

Effect of concurrent use of anti‐retroviral therapy and levonorgestrel sub‐dermal implant for contraception on CD4 counts: a prospective cohort study in Kenya

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Implanon® failure in an HIV-positive woman on antiretroviral therapy resulting in two ectopic pregnancies

Cited by 27 publications

References 7 publications

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

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

Effectiveness of hormonal contraception in HIV-infected women using antiretroviral therapy

Effect of concurrent use of anti‐retroviral therapy and levonorgestrel sub‐dermal implant for contraception on CD4 counts: a prospective cohort study in Kenya

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About

Implanon^® failure in an HIV-positive woman on antiretroviral therapy resulting in two ectopic pregnancies