Technical Issue Brief: Drug Interactions Between Hormonal Contraceptive Methods and Anti-Retroviral Medications Used to Treat HIV

These concerns are centered on the possibility of decreased efficacy of either medication, leading to increased risk of unintended pregnancy and treatment failure. The World Health Organization recommends a first-line regimen for adults and adolescents that includes an NNRTI, two NRTIs, and a fixed-dose combination. However, this regimen may be contraindicated or unavailable in some cases, necessitating the use of alternative medications. Pharmacokinetic studies have evaluated changes in blood levels of contraceptive hormones and ARVs when used simultaneously. However, the clinical significance of these interactions can be difficult to determine without prospective studies that assess pregnancy or ovulation in HIV-positive women taking ART. Long-acting methods like implants are highly effective and require little user input, so slight reductions in contraceptive efficacy may not significantly impact their effectiveness. The evidence suggests that certain ARVs, including NNRTIs, PIs, and integrase inhibitors, may interact with hormonal contraceptive methods. Specifically, efavirenz, ritonavir-boosted PIs, and cobicistat-boosted elvitegravir have been shown to decrease progestin levels in COCs, potentially increasing the risk of pregnancy. Conversely, cobicistat-boosted elvitegravir has been found to lower ethinyl estradiol levels but increase norelgestromin levels, maintaining contraceptive efficacy. Progestin-only injectables, such as DMPA or Net-En, do not appear to have their levels reduced by some PIs, but no efficacy data are available. Levels of DMPA do not appear to be reduced by ARVs, including efavirenz, zidovudine, lamivudine, and nevirapine. However, studies on Net-En used with ART are not available. Contraceptive implants, such as levonorgestrel-releasing intrauterine devices (IUDs), have been found to have their efficacy reduced by efavirenz in a retrospective chart review. This suggests that efavirenz may decrease the efficacy of levonorgestrel implants compared to use by women living with HIV not using efavirenz. Additional data are needed to confirm this finding. The use of hormonal contraceptive methods and antiretroviral medications to treat HIV requires careful consideration of potential drug interactions. Healthcare providers should be aware of the evidence on these interactions and provide guidance to women living with HIV who use these medications. This includes informing them about the potential risks and benefits of using hormonal contraceptive methods and ART simultaneously. The World Health Organization recommends that women living with HIV who use hormonal contraceptive methods and ART should be informed about the potential risks and benefits of these interactions. They should also be provided with guidance on how to minimize these risks and maintain effective contraception and ART regimens. This includes using long-acting methods like implants, which are highly effective and require little user input. In conclusion, the use of hormonal contraceptive methods and antiretroviral medications to treat HIV has raised concerns about potential drug interactions. These concerns are centered on the possibility of decreased efficacy of either medication, leading to increased risk of unintended pregnancy and treatment failure. The evidence suggests that certain ARVs, including NNRTIs, PIs, and integrase inhibitors, may interact with hormonal contraceptive methods. Healthcare providers should be aware of the evidence on these interactions and provide guidance to women living with HIV who use these medications.