Women taking various forms of hormonal contraceptives can likely combine them safely with antiretrovirals (ARVs), whether as HIV treatment or in the form of Truvada (tenofovir disoproxil fumarate/emtricitabine) as pre-exposure prophylaxis (PrEP) against the virus. The one ARV that may be problematic to combine with such forms of birth control is Sustiva (efavirenz), which is included in Atripla (efavirenz/tenofovir disoproxil fumarate/emtricitabine).
Researchers from FHI 360–Durham, University of North Carolina Medical School-Chapel Hill, Johns Hopkins University School of Medicine, division of pharmacology, discipline of pharmaceutical sciences, University of KwaZulu-Natal, division of reproductive health, US Centres for Disease Control and Prevention and the department of reproductive health and research, World Health Organisation, conducted a systematic review of published literature through September 2015, ultimately reviewing 50 reports from 46 studies of women using hormonal contraceptives and ARVs at the same time, whether for treatment or as PrEP. They looked for changes in the effectiveness, toxicity and pharmaco-kinetics (how the drugs are metabolised, including changes in drug levels in the body) of each treatment.
The researchers found that most ARVs, whether used as treatment or prevention, have limited drug-drug interactions with hormonal contraceptives. The standout exception was Sustiva. The limited data available suggest that Sustiva, and by extension Atripla, may compromise the effectiveness of hormonal birth control, with the exception of depot medroxyprogesterone acetate. Any drug-drug interactions with Sustiva notwithstanding, birth control implants remain very effective when paired with the drug.
Hormonal contraceptives do not apparently affect plasma levels or the effectiveness of ARVs. According to the available data, taking PrEP does not reduce the effectiveness of hormonal contraceptives.
The researchers concluded: “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.”
Abstract
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.
Authors
Nanda, Kavita; Stuart, Gretchen S; Robinson, Jennifer; Gray, Andrew L; Tepper, Naomi K; Gaffield, Mary E
[link url="https://www.poz.com/article/taking-birth-control-hiv-treatment-prep-largely-ok"]POZ report[/link]
[link url="http://journals.lww.com/aidsonline/Fulltext/2017/04240/Drug_interactions_between_hormonal_contraceptives.5.aspx"]AIDS abstract[/link]