Interactions between Hormonal Contraception and Anti-Retroviral Therapy: An Updated Review.

• Type of Material: Article
• Authors: Gopika R Krishna, Emory University; Lisa Haddad, Emory University
• Language: English
• Date: 2020-09
• Publisher: Springer Nature
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020, Springer Science Business Media, LLC, part of Springer Nature
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1007/s13669-020-00289-7
• Title of Journal or Parent Work: Curr Obstet Gynecol Rep
• Volume: 9
• Issue: 3
• Start Page: 98
• End Page: 104
• Keywords: anti-retroviral therapy; hormonal contraception; contraception; HIV

Abstract

PURPOSE OF REVIEW: Hormonal contraception provides women living with HIV the ability to control their fertility and avoid pregnancy-related morbidity. Due to shared metabolic pathways, there has been concern over drug-drug interactions between hormonal contraception and anti-retroviral therapy, which may affect the drugs' safety and efficacy. This article aims to provide an updated review of the most recent data around hormonal contraceptives and anti-retroviral therapy. RECENT FINDINGS: Prior data have suggested possible pharmacologic interactions between certain hormonal contraceptives and anti-retroviral therapy. The most significant interactions implicated include those between progestin-based contraceptive implants and efavirenz as well as between combined hormonal contraceptives and protease inhibitors. Most past studies, however, feature small sample sizes with few clinical outcomes reported. SUMMARY: Recent data since 2017 have largely affirmed prior studies on this topic, showing possible pharmacokinetic relationships between certain contraceptives and anti-retrovirals. Notably, while the effectiveness of progestin-based contraceptives, specifically the implant, appears reduced with efavirenz use, the overall effectiveness may remain higher than most other contraceptive methods. Larger studies are needed to provide further guidance before contraceptive-prescribing recommendations can be changed.