ART Limits Appropriate Contraceptive Options for Women with HIV

Hormonal contraceptives with potential drug-drug interactions (DDI) with antiretroviral therapy (ART) are commonly prescribed to women living with HIV (WLH), according to retrospective study findings reported at IDWeek 2017.

“Over half of the 317 WLH on ART reported using contraception (169/317), of whom 75 (44%) were on hormonal contraceptives and ART,” reported lead study author Milena M. McLaughlin, PharmD, MSc, of Midwestern University Chicago College of Pharmacy, in Downers Grove, IL, and Northwestern Memorial Hospital in Chicago, IL, and coauthors, in a poster presentation.

Contraception for family planning is “critically important” for WLH but potential drug-drug interactions between hormonal contraceptives and ART limit contraception options available to these women.

The study authors sought to determine the type and frequency of hormonal contraceptives and ART prescribed to women with HIV infection and prevalence of resulting DDI potential. The researchers reviewed electronic medical charts for women who were receiving ART. For patients receiving hormonal contraceptives, DDI potential and severity categories were assessed using the University of Liverpool HIV Drug Interactions website.

During the study period, 317 women received 438 ART regimens: ritonavir-boosted PI [protease inhibitor]- (282, 64%), NNRTI- (80, 18%), other- (45, 10%), INSTI-based (31, 7%), Dr McLaughlin reported. Fifty-four percent were African-American.

A progestin intrauterine device was the most common form of contraception reported (43, 57%) followed by injection (17, 23%), or combination oral contraceptive pill (OCP; 9, 12%).

Potential moderate DDI potential was identified for 74 of 113 ART-HC-regimen combinations, “representing 57 (76%) women using ART and hormonal contraceptives,” the researchers reported.

“Ritonavir-boosted PIs were the ART most frequently implicated in a potential DDI (62, 83.8%); for HC, this was the progestin intrauterine device (51, 68.9%) and OCP (17, 23%),” Dr. McLaughlin noted.

“Though frequently used and implicated, the progestin IUD is unlikely to result in a clinically significant DDI with ART, but confirmation of this assumption is warranted,” Dr. McLaughlin noted. “Relative to its frequency of use, there was high prevalence of potential OCP-ART DDI; the clinical implications need to be further explored.”