Concomitant contraceptive implant and efavirenz use in women living with HIV: perspectives on current evidence and policy implications for family planning and HIV treatment guidelines

Journal of the International AIDS Society
Rena C PatelCraig R Cohen

Abstract

Preventing unintended pregnancies is important among all women, including those living with HIV. Increasing numbers of women, including HIV-positive women, choose progestin-containing subdermal implants, which are one of the most effective forms of contraception. However, drug-drug interactions between contraceptive hormones and efavirenz-based antiretroviral therapy (ART) may reduce implant effectiveness. We present four inter-related perspectives on this issue. First, as a case study, we discuss how limited data prompted country-level guidance against the use of implants among women concomitantly using efavirenz in South Africa and its subsequent negative effects on the use of implants in general. Second, we discuss the existing clinical data on this topic, including the observational study from Kenya showing women using implants plus efavirenz-based ART had three-fold higher rates of pregnancy than women using implants plus nevirapine-based ART. However, the higher rates of pregnancy in the implant plus efavirenz group were still lower than the pregnancy rates among women using common alternative contraceptive methods, such as injectables. Third, we discuss the four pharmacokinetic studies that show 50-70% reductions in plas...Continue Reading

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Citations

Aug 27, 2019·The Journal of Clinical Hypertension·Samuel PierreMargaret L McNairy
Nov 16, 2019·Journal of the International AIDS Society·Leo BeacroftTimothy B Hallett
Sep 11, 2019·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Rosie MngqibisaUNKNOWN A5338 Study Team
Mar 29, 2020·Culture, Health & Sexuality·Emily A KrogstadLinda-Gail Bekker
Dec 29, 2020·Clinical Case Reports·Maxwell Tii KumbeniEmmanuel Awine Ayamga
Jan 27, 2020·Contraception·Emily A KrogstadAriane van der Straten
Aug 14, 2021·BMC Medicine·Rena C PatelUNKNOWN Implant/Efavirenz Study Group and the East Africa IeDEA Regional Consortium
Jun 22, 2021·Clinical Pharmacology and Therapeutics·Jose FrancisUNKNOWN A5093, A5283, A5338 study teams

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Methods Mentioned

BETA
contraception

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