TY - JOUR
T1 - Drug interactions between hormonal contraceptives and antiretrovirals
AU - Nanda, Kavita
AU - Stuart, Gretchen S.
AU - Robinson, Jennifer
AU - Gray, Andrew L.
AU - Tepper, Naomi K.
AU - Gaffield, Mary E.
N1 - Funding Information:
This manuscript is made possible by the generous support of the American people through the United States Agency for International Development (USAID), provided to FHI 360 through cooperative agreement number AID-OAA-A-15-00045 and consolidated grant number GHA-G-00-09-00003 provided to the WHO. We also thank Drs Margaret Doherty, Marco De Avila Vitoria, and Shaffiq Essajee for their expert advice. Roles of the authors: The WHO (MLG) initiated the idea to update this systematic review. K.N. led the conduct of the systematic review, conducted the literature searches, and coordinated review procedures and drafting of the manuscript.All authors participated in framing the study questions, developing eligibility criteria, reviewing identified studies for eligibility, abstracting study information, interpreting the data, and contributing to the writing, and editing of the manuscript. All authors reviewed and approved the final manuscript before submission. Source of funding: K.N. has led previous systematic reviews on this topic, and authored a few of the studies included in the review. G.S.S. authored one of the studies included in the review. The WHO and USAID provided support for the writing of this systematic review and for the writing group to attend a working meeting in Geneva, Switzerland, in 2015. Disclaimer: The contents are the responsibility of the authors and do not necessarily reflect represent the official positions of FHI360, USAID, the Centers for Disease Control and Prevention, the WHO, or other institutions with which the authors are affiliated.
Publisher Copyright:
Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc.
PY - 2017/4/24
Y1 - 2017/4/24
N2 - 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.
AB - 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.
KW - Antiretroviral therapy
KW - Contraceptive implant
KW - Depot medroxyprogesterone acetate
KW - HIV
KW - Hormonal contraception
KW - Systematic review
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U2 - 10.1097/QAD.0000000000001392
DO - 10.1097/QAD.0000000000001392
M3 - Review article
C2 - 28060009
AN - SCOPUS:85008367750
SN - 0269-9370
VL - 31
SP - 917
EP - 952
JO - AIDS
JF - AIDS
IS - 7
ER -