51
|
Liu Z, Qiu S, Gu Y, Ning M. Quantitative determination of levonorgestrel in beagle dog plasma after vaginal administration of intravaginal ring by high-performance liquid chromatography-tandem mass spectrometry. Biomed Chromatogr 2018; 32:e4367. [PMID: 30120779 DOI: 10.1002/bmc.4367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/31/2018] [Accepted: 08/09/2018] [Indexed: 11/11/2022]
Abstract
A specific and sensitive high-performance liquid chromatography-tandem mass spectrometry method that could be used to determine the concentration of levonorgestrel (LNG) in beagle dog plasma was developed. Specifically, terfenadine was used as the internal standard (IS). The separation was achieved on a Kinetex-C18 110A column (3 × 30 mm i.d., 2.6 um, Phenomenex) and a gradient mobile phase consists of methanol (0.1% formic acid) and water (0.1% formic acid) was used. The flow rate was 0.8 mL/min and the injection volume was 10 μL. The detection was performed on a triple-quadruple tandem mass spectrometer by multiple reaction monitoring mode via electrospray ionization. Quantitative analysis was carried out at m/z 313.0 → 108.9 and m/z 472.6 → 436.2 for LNG and IS respectively. This method demonstrated the linearity of LNG over a concentration range of 0.5-50 ng/mL with a coefficient correlation (r) of 0.9973. The lower limit of quantification was 0.5 ng/mL. The intra- and inter-assay precisions were 2.9 and 11.2%, with an accuracy range from 94.8 to 108.4%. The stability data indicated that sample preparation and storage process had little effect on the concentration of LNG QC sample. The validated method was successfully applied to study the pharmacokinetics of LNG in beagle dog after vaginal administration of intravaginal ring.
Collapse
Affiliation(s)
- Zhenqi Liu
- Science and Technology Research Center for Reproductive Health, National Research Institute for Family Planning, Beijing, China
| | - Shunchen Qiu
- Science and Technology Research Center for Reproductive Health, National Research Institute for Family Planning, Beijing, China
| | - Yiqun Gu
- Science and Technology Research Center for Reproductive Health, National Research Institute for Family Planning, Beijing, China
| | - Meiying Ning
- Science and Technology Research Center for Reproductive Health, National Research Institute for Family Planning, Beijing, China
| |
Collapse
|
52
|
Abstract
PURPOSE OF REVIEW Contraception is a vital component of medical care for women with HIV or at high risk of acquiring HIV. Over the last several years, there has been emerging evidence regarding the safety and effectiveness of various contraceptive methods, ultimately leading to a revision in the WHO Medical Eligibility Criteria for contraceptive use. RECENT FINDINGS Progestogen-only injectables may be associated with an increased risk of HIV acquisition and its use has been revised to category 2 from category 1. Etonogestrel and levonorgestrel levels are lower in women who concurrently use contraceptive implant and efavirenz-based antiretroviral therapy. Multipurpose technology, aimed at providing antiretroviral medication and contraception, is an area of ongoing research but is not yet clinically available. SUMMARY It is important for providers who care for women with HIV or at high risk of HIV to inquire about pregnancy intentions. If contraception is desired, these women should be offered all available methods, with counseling regarding possible risks of contraceptive failure or HIV acquisition.
Collapse
|
53
|
Krashin JW, Haddad LB, Tweya H, Chiwoko J, Ng’ambi W, Samala B, Chaweza T, Tang JH, Hosseinipour MC, Phiri S. Factors associated with desired fertility among HIV-positive women and men attending two urban clinics in Lilongwe, Malawi. PLoS One 2018; 13:e0198798. [PMID: 29897961 PMCID: PMC5999219 DOI: 10.1371/journal.pone.0198798] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 05/27/2018] [Indexed: 12/24/2022] Open
Abstract
As access to antiretroviral therapy increases, more HIV-infected patients in sub-Saharan Africa may desire fertility. We conducted a cross-sectional study of reproductive health knowledge, attitudes and practices to identify factors associated with desired fertility among women and men receiving care at two large public HIV clinics in Lilongwe, Malawi. Research assistants administered questionnaires to participants. We performed descriptive, bivariable and multivariable analysis of factors related to desired fertility and of factors related to contraceptive non-use among participants who did not desire fertility. One-third of participants desired future children. Having a partner who desired fertility and having lower parity were associated with desiring children among both genders. For women, believing that pregnancy was unhealthy was associated with decreased fertility desire. Fifty-five percent of women and 69% of men who did not want children in the future reported using contraception at last intercourse. Increasing age, lower parity, and making the decision to use contraception herself were associated with contraceptive non-use among women who did not desire fertility. Having discussed family planning with his partner was associated with contraceptive use among men who did not desire fertility. Knowledge of these factors can guide reproductive health counseling and service provision.
Collapse
Affiliation(s)
- Jamie W. Krashin
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
- * E-mail:
| | - Lisa B. Haddad
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Hannock Tweya
- The Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Jane Chiwoko
- The Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi
| | | | | | - Thomas Chaweza
- The Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Jennifer H. Tang
- Department of Obstetrics & Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
- UNC Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Mina C. Hosseinipour
- UNC Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Sam Phiri
- The Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| |
Collapse
|
54
|
Cirrincione LR, Penchala SD, Scarsi KK, Podany AT, Winchester LC, Back DJ, Khoo SH, Fletcher CV, Siccardi M, Else LJ. Development, validation and utilization of a highly sensitive LC-MS/MS method for quantification of levonorgestrel released from a subdermal implant in human plasma. J Chromatogr B Analyt Technol Biomed Life Sci 2018; 1084:106-112. [PMID: 29579732 PMCID: PMC5892837 DOI: 10.1016/j.jchromb.2018.03.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 03/07/2018] [Accepted: 03/11/2018] [Indexed: 01/11/2023]
Abstract
Levonorgestrel (LNG) is a synthetic progestin that is available in oral contraceptive tablets, a subdermal implant, and an intrauterine system for contraception. LNG pharmacokinetics are a pivotal determinant of contraceptive efficacy and essential in assessing drug-drug interactions influencing LNG exposure following different routes of LNG administration. A highly sensitive LC-MS/MS method was developed and validated to quantify levonorgestrel in human plasma. Liquid-liquid extraction was utilized with a sample volume of 500 μL to extract levonorgestrel from plasma. Chromatographic separation of LNG was achieved with a Fortis™ C18 (3 μm: 100 mm × 2.1 mm) reverse phase analytical column. The mobile phases consisted of de-ionized water plus 0.1% NH4OH (100:0.1%, v/v) (A), and methanol plus 0.1% NH4OH (100:0.1%, v/v) (B) delivered as a gradient at a flow rate of 400 μL/min. Detection of LNG and internal standard (D-(-)-norgestrel-d7) was achieved using positive polarity mode monitoring at 313.2-245.2 amu and 320.1-251.2 amu, respectively. The assay was linear over the calibration range of 49.6 to 1500 pg/mL. This method was used to quantify plasma LNG released by subdermal implant in support of a drug interaction study among women with HIV receiving efavirenz- or nevirapine-based antiretroviral therapy.
Collapse
Affiliation(s)
- Lauren R Cirrincione
- Antiviral Pharmacology Laboratory, Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sujan Dilly Penchala
- Department of Molecular & Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Kimberly K Scarsi
- Antiviral Pharmacology Laboratory, Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Anthony T Podany
- Antiviral Pharmacology Laboratory, Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Lee C Winchester
- Antiviral Pharmacology Laboratory, Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - David J Back
- Department of Molecular & Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Saye H Khoo
- Department of Molecular & Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Courtney V Fletcher
- Antiviral Pharmacology Laboratory, Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Marco Siccardi
- Department of Molecular & Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Laura J Else
- Department of Molecular & Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
| |
Collapse
|
55
|
Nwaohiri AN, Tang JH, Stanczyk F, Chinula L, Hurst S, Davis NL, Tegha G, Haddad L, Kourtis AP. Discordance between self-reported contraceptive use and detection of exogenous hormones among Malawian women enrolling in a randomized clinical trial. Contraception 2018; 97:354-356. [PMID: 29246819 PMCID: PMC5840008 DOI: 10.1016/j.contraception.2017.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/05/2017] [Accepted: 12/05/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective was to assess the extent of concordance between self-reported contraceptive use and the presence of contraceptive progestins in serum. STUDY DESIGN We evaluated self-reported contraceptive use by using radioimmunoassay to examine baseline serum levels of medroxyprogesterone acetate (MPA) and levonorgestrel (LNG) among 97 Malawian women enrolling in a contraceptive trial. RESULTS Twelve percent (12/97) of study participants who reported no hormonal contraceptive use in the previous 6months had either MPA or LNG detected in their serum. CONCLUSIONS The observed discordance between self-report and detection of exogenous hormones in serum indicates that caution is warranted when drawing conclusions based on self-reported contraceptive use.
Collapse
Affiliation(s)
- Anuli N Nwaohiri
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Frank Stanczyk
- Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine
| | | | - Stacey Hurst
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nicole L Davis
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gerald Tegha
- University of North Carolina Project, Lilongwe, Malawi
| | - Lisa Haddad
- Emory University, Department of Obstetrics & Gynecology, Atlanta, GA, USA
| | - Athena P Kourtis
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| |
Collapse
|
56
|
A systematic review of contraceptive continuation among women living with HIV. Contraception 2018; 98:8-24. [PMID: 29432719 DOI: 10.1016/j.contraception.2018.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 01/29/2018] [Accepted: 02/03/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Women living with HIV (WLHIV) experience high rates of unmet contraceptive need and unintended pregnancy. Contraceptive method-specific continuation rates and associated factors are critical for guiding providers tasked with both reproductive health (RH) and HIV care. We conducted this systematic review to determine whether contraceptive continuation rates differ between WLHIV and uninfected women and, for WLHIV, whether differences are impacted by method type, antiretroviral therapy use or other factors. METHODS We searched Ovid MEDLINE, POPLINE and PubMed.gov for studies published between January 1, 2000, and August 31, 2016. Inclusion criteria comprised prospective data of WLHIV, nonbarrier method continuation as an outcome measure, and recorded method switching and/or discontinuation. RESULTS Of 939 citations screened, 22 articles from 18 studies were eligible. For studies with comparator groups, data quality was moderate overall based on Grading of Recommendations, Assessment, Development and Evaluations and Newcastle-Ottawa Quality Assessment scales. Of four studies comparing women by HIV serostatus, two showed higher rates of contraceptive continuation among WLHIV versus uninfected women, while two others detected lower continuation rates for the same comparison. Generally, baseline method continuation exceeded 60% for studies with >12months of follow-up. Studies providing contraception had higher continuation rates than studies not providing contraception, while women allocated to contraceptive methods in trials had similar continuation rates to those choosing contraceptive methods. Across all studies, continuation rates differed by method and context, with the copper intrauterine device showing greatest variability between sites (51%-91% continuation rates at ≥12months). Implant continuation rates were ≥86%, though use was low relative to other methods and limited to few studes. CONCLUSIONS Contraceptive continuation among WLHIV differs by method and context. More longitudinal studies with contraceptive continuation as a measured outcome following ≥12months are needed to strengthen integration of RH and HIV care.
Collapse
|
57
|
Miles CH, Shpitser I, Kanki P, Meloni S, Tchetgen EJT. Quantifying an Adherence Path-Specific Effect of Antiretroviral Therapy in the Nigeria PEPFAR Program. J Am Stat Assoc 2018; 112:1443-1452. [PMID: 32042214 DOI: 10.1080/01621459.2017.1295862] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Since the early 2000s, evidence has accumulated for a significant differential effect of first-line antiretroviral therapy (ART) regimens on human immunodeficiency virus (HIV) viral load suppression. This finding was replicated in our data from the Harvard President's Emergency Plan for AIDS Relief (PEPFAR) program in Nigeria. Investigators were interested in finding the source of these differences, i.e., understanding the mechanisms through which one regimen outperforms another, particularly via adherence. This question can be naturally formulated via mediation analysis with adherence playing the role of a mediator. Existing mediation analysis results, however, have relied on an assumption of no exposure-induced confounding of the intermediate variable, and generally require an assumption of no unmeasured confounding for nonparametric identification. Both assumptions are violated by the presence of drug toxicity. In this paper, we relax these assumptions and show that certain path-specific effects remain identified under weaker conditions. We focus on the path-specific effect solely mediated by adherence and not by toxicity and propose an estimator for this effect. We illustrate with simulations and present results from a study applying the methodology to the Harvard PEPFAR data. Supplementary materials are available online.
Collapse
Affiliation(s)
- Caleb H Miles
- Postdoctoral Fellow, Division of Biostatistics, University of California, Berkeley, Berkeley, CA 94720-7358
| | - Ilya Shpitser
- Assistant Professor, Department of Computer Science, Johns Hopkins University, Baltimore, MD 21218-2608
| | - Phyllis Kanki
- Research Associate, Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115
| | - Seema Meloni
- Research Associate, Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115
| | - Eric J Tchetgen Tchetgen
- Professor, Departments of Biostatistics and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA 02115
| |
Collapse
|
58
|
Neary M, Owen A. Pharmacogenetic considerations for HIV treatment in different ethnicities: an update. Expert Opin Drug Metab Toxicol 2017; 13:1169-1181. [DOI: 10.1080/17425255.2017.1391214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- M. Neary
- Infection Pharmacology Group, University of Liverpool, Liverpool, UK
| | - A. Owen
- Infection Pharmacology Group, University of Liverpool, Liverpool, UK
| |
Collapse
|
59
|
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. J Int AIDS Soc 2017; 20:21396. [PMID: 28530033 PMCID: PMC5515020 DOI: 10.7448/ias.20.1.21396] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: 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. Discussion: 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 plasma progestin concentrations in women concurrently using efavirenz-based ART as compared to women not on any ART. These pharmacokinetic studies provide the biologic basis for the clinical findings. Fourth, we discuss how data on this topic have marked implications for both family planning and HIV programmes and policies globally. Conclusion: This controversy underlines the importance of integrating family planning services into routine HIV care, counselling women appropriately on increased risk of pregnancy with concomitant implant and efavirenz use, and expanding contraceptive method mix for all women. As global access to ART expands, greater research is needed to explore implant effectiveness when used concomitantly with newer ART regimens. Data on how HIV-positive women and their partners choose contraceptives, as well as information from providers on how they present and counsel patients on contraceptive options are needed to help guide policy and service delivery. Lastly, greater collaboration between HIV and reproductive health experts at all levels are needed to develop successful strategies to ensure the best HIV and reproductive health outcomes for women living with HIV.
Collapse
|
60
|
Drug interactions and the role of pharmacokinetic trials in guiding choices in first-line HIV therapy in low-income and middle-income countries. Curr Opin HIV AIDS 2017; 12:377-382. [PMID: 28570369 DOI: 10.1097/coh.0000000000000384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE OF REVIEW Low- and middle-income countries (LMICs) face specific challenges in the treatment of people living with HIV. Drug-drug interactions (DDIs) involving antiretrovirals (ARVs) are prevalent in all settings and have considerable potential to cause clinical harm to patients via toxicity or reduced efficacy of treatment. Differing comorbidities, endemic infections and traditional medicines may complicate ARV therapy (ART) in LMICs, which usually takes a public health approach in these settings, with fewer alternative regimens available. This review discusses the issues surrounding pharmacokinetic DDI studies and their application to ART in LMICs, with particular reference to first-line ART regimens. RECENT FINDINGS Pharmacokinetic studies with clinical endpoints are the gold standard for informing management of DDIs; however, data relevant to LMICs are sparse and of low quality. There is significant potential for clinically relevant DDIs between ARVs and antimalarials, antimycobacterials and drugs used in the treatment of neglected tropical diseases. SUMMARY Many pharmacokinetic studies are difficult to interpret in LMICs due to differences in patient factors including weight, disease state and genetic polymorphisms. DDI studies relevant to LMICs may also be lacking due to the neglected nature of relevant comorbidities. The ARVs currently available as first-line ART in LMICs are among those with highest propensity for DDIs.
Collapse
|
61
|
Brief Report: Dapivirine Vaginal Ring Use Does Not Diminish the Effectiveness of Hormonal Contraception. J Acquir Immune Defic Syndr 2017; 76:e47-e51. [PMID: 28542081 DOI: 10.1097/qai.0000000000001455] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the potential for a clinically relevant drug-drug interaction with concomitant use of a dapivirine vaginal ring, a novel antiretroviral-based HIV-1 prevention strategy, and hormonal contraception by examining contraceptive efficacies with and without dapivirine ring use. DESIGN A secondary analysis of women participating in MTN-020/ASPIRE, a randomized, double-blind, placebo-controlled trial of the dapivirine vaginal ring for HIV-1 prevention. METHODS Use of a highly effective method of contraception was an eligibility criterion for study participation. Urine pregnancy tests were performed monthly. Pregnancy incidence by arm was calculated separately for each hormonal contraceptive method and compared using an Andersen-Gill proportional hazards model stratified by site and censored at HIV-1 infection. RESULTS Of 2629 women enrolled, 2310 women returned for follow-up and reported using a hormonal contraceptive method at any point during study participation (1139 in the dapivirine arm and 1171 in the placebo arm). Pregnancy incidence in the dapivirine arm versus placebo among women using injectable depot medroxyprogesterone acetate was 0.43% vs. 0.54%, among women using injectable norethisterone enanthate was 1.15% vs. 0%, among women using hormonal implants was 0.22% vs. 0.69%, and among women using oral contraceptive pills was 32.26% vs. 28.01%. Pregnancy incidence did not differ by study arm for any of the hormonal contraceptive methods. CONCLUSIONS Use of the dapivirine ring does not reduce the effectiveness of hormonal contraceptives for pregnancy prevention. Oral contraceptive pill use was associated with high pregnancy incidence, potentially because of poor pill adherence. Injectable and implantable methods were highly effective in preventing pregnancy.
Collapse
|
62
|
Patel RC, Bukusi EA, Baeten JM. Current and future contraceptive options for women living with HIV. Expert Opin Pharmacother 2017; 19:1-12. [PMID: 28891343 DOI: 10.1080/14656566.2017.1378345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Among women living with HIV, half of the pregnancies are unintended. Effective contraception can prevent unintended pregnancies and consequently reduce maternal mortality and perinatal transmission of HIV. While contraceptive options available for all women also apply to women living with HIV, specific considerations exist to the use of contraception by women living with HIV. AREAS COVERED First, general principles guiding the use of contraception among women living with HIV are discussed, such as choice, method mix, relative effectiveness, and drug-drug interactions. Second, a detailed discussion of each contraceptive method and issues surrounding the use of that method, such as drug-drug interactions, follows. Third, future contraceptive options in advanced development for use by women or men are briefly discussed. EXPERT OPINION Contraceptive methods available to all women should also be accessible to women living with HIV. When the relative effectiveness of a contraceptive method is reduced, for example due to drug-drug interactions with antiretrovirals, the method should still be made available to women living with HIV with the appropriate information sharing and counseling. Greater research on various aspects of contraceptive use by women living with HIV and more comprehensive testing of co-administration of hormonal contraceptives and common medications used by these women are warranted.
Collapse
Affiliation(s)
- Rena C Patel
- a Division of Allergy and Infectious Diseases, Department of Medicine , University of Washington , Seattle , WA , USA
| | - Elizabeth A Bukusi
- b Centre for Microbiologic Research , Kenya Medical Research Institute ; Nairobi , Kenya.,c Departments of Obstetrics and Gynecology and Global Health , University of Washington ; Seattle , WA , USA
| | - Jared M Baeten
- d Departments of Epidemiology, Global Health, and Medicine , University of Washington ; Seattle , WA , USA
| |
Collapse
|
63
|
Efavirenz decreases etonogestrel exposure: a pharmacokinetic evaluation of implantable contraception with antiretroviral therapy. AIDS 2017; 31:1965-1972. [PMID: 28692531 DOI: 10.1097/qad.0000000000001591] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The primary objective of this study was to characterize the pharmacokinetics of etonogestrel (ENG) released from a contraceptive implant in Ugandan women living with HIV who were receiving efavirenz (EFV) or nevirapine (NVP)-based antiretroviral therapy (ART), compared with ART-naive women over 24 weeks. DESIGN Nonrandomized, parallel-group study with three arms: ART-naive, NVP, or EFV-based ART (N = 20/group). METHODS Sparse pharmacokinetic sampling of ENG, NVP, or EFV were performed at screening, entry, and then 1, 4, 12, and 24-week postimplant insertion. The primary endpoint was ENG concentrations at week 24, compared between the ART-naive group and each ART group, using geometric mean ratio (GMR) with 90% confidence intervals. RESULTS Sixty participants competed the 24-week study and data from 58 participants are included; one participant each was excluded from the NVP group and EFV group because of a sample processing error and ART nonadherence, respectively. At week 24, geometric mean ENG was 362, 341, and 66 pg/ml in the ART-naive, NVP, and EFV groups, respectively [GMR: NVP : ART-naive 0.94 (0.90-1.01); EFV : ART-naive 0.18 (0.17-0.20)]. NVP and EFV concentrations were lower at week 24 compared to preimplant [NVP: geometric mean 5.7 versus 6.8 mg/l, respectively, GMR 0.84 (0.83-0.85); EFV: geometric mean 3.6 versus 4.9 mg/l, respectively, GMR 0.73 (0.69-0.80)]. CONCLUSION After 24 weeks of combined use, ENG exposure was 82% lower in women using EFV-based ART compared with ART-naive women. In contrast, NVP did not significantly impact ENG exposure. These results raise concerns about reduced effectiveness of implantable contraception for women taking EFV-based ART.
Collapse
|
64
|
Cohn SE. Women in HIV trials: improving adherence and outcomes. Lancet HIV 2017; 4:e530-e531. [PMID: 28729157 DOI: 10.1016/s2352-3018(17)30107-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 05/25/2017] [Accepted: 05/25/2017] [Indexed: 01/02/2023]
Affiliation(s)
- Susan E Cohn
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
| |
Collapse
|
65
|
Sharma A, Jaiswal S, Shukla M, Lal J. Effect of arteether and pyrimethamine coadministration on the pharmacokinetic and pharmacodynamic profile of ormeloxifene. Naunyn Schmiedebergs Arch Pharmacol 2017; 390:971-976. [PMID: 28689253 DOI: 10.1007/s00210-017-1401-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/28/2017] [Indexed: 11/30/2022]
Abstract
The study was intended to investigate the effect of concomitant administration of antimalarial drug (pyrimethamine or arteether) on pharmacokinetic and post coitus contraceptive efficacy of ormeloxifene in female Sprague-Dawley rats. A serial sampling technique coupled with LC-MS/MS detection was utilized for quantification of ormeloxifene in plasma samples collected from female rats treated with ormeloxifene only and ormeloxifene with pyrimethamine or arteether. Coitus-proven female rats were utilized to investigate the effect of pyrimethamine or arteether coadministration on contraceptive efficacy of ormeloxifene by investigating the presence or absence of implantations and status of corpora lutea on day 10 post coitum. None of the sperm-positive rats treated with ormeloxifene with or without coadministration of pyrimethamine or arteether showed any sign of pregnancy, confirming that concomitant administration of antimalarial drugs (pyrimethamine or arteether) did not affect the pharmacodynamic profile of ormeloxifene. Although there was no sign of pharmacodynamic interaction, the volume of distribution of ormeloxifene increased significantly on cotreatment with pyrimethamine. However, coadministration of arteether did not affect any of the pharmacokinetic parameters of ormeloxifene. The compiled results of preliminary study in female rats support that pyrimethamine or arteether can be prescribed with ormeloxifene.
Collapse
Affiliation(s)
- Abhisheak Sharma
- Pharmacokinetics & Metabolism Division, CSIR-Central Drug Research Institute, Jankipuram Extension, Sitapur Road, Lucknow, 226031, India.,Academy of Scientific and Innovative Research, New Delhi, 110025, India.,Department of Pharmaceutics, University of Florida, Gainesville, FL, 32610, USA
| | - Swati Jaiswal
- Pharmacokinetics & Metabolism Division, CSIR-Central Drug Research Institute, Jankipuram Extension, Sitapur Road, Lucknow, 226031, India.,Academy of Scientific and Innovative Research, New Delhi, 110025, India
| | - Mahendra Shukla
- Pharmacokinetics & Metabolism Division, CSIR-Central Drug Research Institute, Jankipuram Extension, Sitapur Road, Lucknow, 226031, India.,Academy of Scientific and Innovative Research, New Delhi, 110025, India
| | - Jawahar Lal
- Pharmacokinetics & Metabolism Division, CSIR-Central Drug Research Institute, Jankipuram Extension, Sitapur Road, Lucknow, 226031, India. .,Academy of Scientific and Innovative Research, New Delhi, 110025, India.
| |
Collapse
|
66
|
Practice Bulletin No. 167: Gynecologic Care for Women and Adolescents With Human Immunodeficiency Virus. Obstet Gynecol 2017; 128:e89-e110. [PMID: 27661659 DOI: 10.1097/aog.0000000000001707] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In the United States in 2013, there were an estimated 226,000 women and adolescents living with human immunodeficiency virus (HIV) infection (1). Women with HIV are living longer, healthier lives, so the need for routine and problem-focused gynecologic care has increased. The purpose of this document is to educate clinicians about basic health screening and care, family planning, prepregnancy care, and managing common gynecologic problems for women and adolescents who are infected with HIV. For information on screening guidelines, refer to the American College of Obstetricians and Gynecologists' Committee Opinion No. 596, Routine Human Immunodeficiency Virus Screening (2).
Collapse
|
67
|
Neary M, Lamorde M, Olagunju A, Darin KM, Merry C, Byakika-Kibwika P, Back DJ, Siccardi M, Owen A, Scarsi KK. The Effect of Gene Variants on Levonorgestrel Pharmacokinetics When Combined With Antiretroviral Therapy Containing Efavirenz or Nevirapine. Clin Pharmacol Ther 2017; 102:529-536. [PMID: 28187506 DOI: 10.1002/cpt.667] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/16/2017] [Accepted: 02/04/2017] [Indexed: 12/31/2022]
Abstract
Reduced levonorgestrel concentrations from the levonorgestrel contraceptive implant was previously seen when given concomitantly with efavirenz. We sought to assess whether single nucleotide polymorphisms (SNPs) in genes involved in efavirenz and nevirapine metabolism were linked to these changes in levonorgestrel concentration. SNPs in CYP2B6, CYP2A6, NR1I2, and NR1I3 were analyzed. Associations of participant demographics and genotype with levonorgestrel pharmacokinetics were evaluated in HIV-positive women using the levonorgestrel implant plus efavirenz- or nevirapine-based antiretroviral therapy (ART), in comparison to ART-naïve women using multivariate linear regression. Efavirenz group: CYP2B6 516G>T was associated with lower levonorgestrel log10 Cmax and log10 AUC. CYP2B6 15582C>T was associated with lower log10 AUC. Nevirapine group: CYP2B6 516G>T was associated with higher log10 Cmax and lower log10 Cmin . Pharmacogenetic variations influenced subdermal levonorgestrel pharmacokinetics in HIV-positive women, indicating that the magnitude of the interaction with non-nucleoside reverse transcriptase inhibitors (NNRTIs) is influenced by host genetics.
Collapse
Affiliation(s)
- M Neary
- Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - M Lamorde
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - A Olagunju
- Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - K M Darin
- Center for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - C Merry
- Department of Medicine, Trinity College Dublin, Dublin, Ireland
| | - P Byakika-Kibwika
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - D J Back
- Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - M Siccardi
- Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - A Owen
- Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - K K Scarsi
- Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, Omaha, Nebraska, USA
| |
Collapse
|
68
|
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.
Collapse
|
69
|
Mason J, Medley A, Yeiser S, Nightingale VR, Mani N, Sripipatana T, Abutu A, Johnston B, Watts DH. The role of family planning in achieving safe pregnancy for serodiscordant couples: commentary from the United States government's interagency task force on family planning and HIV service integration. J Int AIDS Soc 2017; 20:21312. [PMID: 28361500 PMCID: PMC5461116 DOI: 10.7448/ias.20.2.21312] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 12/21/2016] [Accepted: 12/27/2016] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION People living with HIV (PLHIV) have the right to exercise voluntary choices about their health, including their reproductive health. This commentary discusses the integral role that family planning (FP) plays in helping PLHIV, including those in serodiscordant relationships, achieve conception safely. The United States (US) President's Emergency Plan for AIDS Relief (PEPFAR) is committed to meeting the reproductive health needs of PLHIV by improving their access to voluntary FP counselling and services, including prevention of unintended pregnancy and counselling for safer conception. DISCUSSION Inclusion of preconception care and counselling (PCC) as part of routine HIV services is critical to preventing unintended pregnancies and perinatal infections among PLHIV. PLHIV not desiring a current pregnancy should be provided with information and counselling on all available FP methods and then either given the method onsite or through a facilitated referral process. PLHIV, who desire children should be offered risk reduction counselling, support for HIV status disclosure and partner testing, information on safer conception options to reduce the risk of HIV transmission to the partner and the importance of adhering to antiretroviral treatment during pregnancy and breastfeeding to reduce the risk of vertical transmission to the infant. Integration of PCC, HIV and FP services at the same location is recommended to improve access to these services for PLHIV. Other considerations to be addressed include the social and structural context, the health system capacity to offer these services, and stigma and discrimination of providers. CONCLUSION Evaluation of innovative service delivery models for delivering PCC services is needed, including provision in community-based settings. The US Government will continue to partner with local organizations, Ministries of Health, the private sector, civil society, multilateral and bilateral donors, and other key stakeholders to strengthen both the policy and programme environment to ensure that all PLHIV and serodiscordant couples have access to FP services, including prevention of unintended pregnancy and safer conception counselling.
Collapse
Affiliation(s)
- Jennifer Mason
- Office of Population and Reproductive Health, U.S. Agency for International Development, Arlington, VA, USA
| | - Amy Medley
- Division of Global HIV and AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sarah Yeiser
- Office of HIV/AIDS, U.S. Agency for International Development, Arlington, VA, USA
| | | | - Nithya Mani
- Office of HIV/AIDS, U.S. Agency for International Development, Arlington, VA, USA
| | - Tabitha Sripipatana
- Office of Population and Reproductive Health, U.S. Agency for International Development, Arlington, VA, USA
| | - Andrew Abutu
- Division of Global HIV and AIDS, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Beverly Johnston
- Office of Population and Reproductive Health, U.S. Agency for International Development, Arlington, VA, USA
| | - D. Heather Watts
- Office of the U.S. Global AIDS Coordinator, U.S. Department of State, Washington, DC, USA
| |
Collapse
|
70
|
Trezza C, Ford SL, Gould E, Lou Y, Huang C, Ritter JM, Buchanan AM, Spreen W, Patel P. Lack of effect of oral cabotegravir on the pharmacokinetics of a levonorgestrel/ethinyl oestradiol-containing oral contraceptive in healthy adult women. Br J Clin Pharmacol 2017; 83:1499-1505. [PMID: 28087972 PMCID: PMC5465324 DOI: 10.1111/bcp.13236] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 12/28/2016] [Accepted: 01/04/2017] [Indexed: 11/27/2022] Open
Abstract
AIMS This study aimed to investigate whether cabotegravir (CAB), an integrase inhibitor in development for treatment and prevention of human immunodeficiency virus-1, influences the pharmacokinetics (PK) of a levonorgestrel (LNG) and ethinyl oestradiol (EO)-containing oral contraceptive (OC) in healthy women. METHODS In this open-label, fixed-sequence crossover study, healthy female subjects received LNG 0.15 mg/EO 0.03 mg tablet once daily Days 1-10 alone and with oral CAB 30 mg once daily Days 11-21. At the end of each treatment period, subjects underwent predose sampling for concentrations of follicle-stimulating hormone, luteinizing hormone, and progesterone and serial PK sampling for plasma LNG, EO, and CAB concentrations. RESULTS Twenty women were enrolled, and 19 completed the study. One subject was withdrawn due to an adverse event unrelated to study medications. Geometric least squares mean ratios (90% confidence interval) of LNG + CAB vs. LNG alone for LNG area under the plasma concentration-time curve over the dosing interval of duration τ and maximum observed plasma concentration were 1.12 (1.07-1.18) and 1.05 (0.96-1.15), respectively. Geometric least squares mean ratio (90% confidence interval) of EO + CAB vs. EO alone for EO area under the plasma concentration-time curve over the dosing interval of duration τ and maximum observed plasma concentration were 1.02 (0.97-1.08) and 0.92 (0.83-1.03), respectively. Steady-state CAB PK parameters were comparable to historical values. There was no apparent difference in mean luteinizing hormone, follicle-stimulating hormone, and progesterone concentrations between periods. No clinically significant trends in laboratory values, vital signs, or electrocardiography values were observed. CONCLUSIONS Repeat doses of oral CAB had no significant effect on LNG/EO PK or pharmacodynamics, which supports CAB coadministration with LNG/EO OCs in clinical practice.
Collapse
Affiliation(s)
| | - Susan L Ford
- PAREXEL International, Research Triangle Park, North Carolina, USA
| | - Elizabeth Gould
- PAREXEL International, Research Triangle Park, North Carolina, USA
| | - Yu Lou
- PAREXEL International, Research Triangle Park, North Carolina, USA
| | - Chuyun Huang
- PAREXEL International, Research Triangle Park, North Carolina, USA
| | | | - Ann M Buchanan
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | - William Spreen
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| | - Parul Patel
- ViiV Healthcare, Research Triangle Park, North Carolina, USA
| |
Collapse
|
71
|
Levonorgestrel in contraceptives and multipurpose prevention technologies: does this progestin increase HIV risk or interact with antiretrovirals? AIDS 2016; 30:2571-2576. [PMID: 27525548 DOI: 10.1097/qad.0000000000001229] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
72
|
A randomized clinical trial on the effects of progestin contraception in the genital tract of HIV-infected and uninfected women in Lilongwe, Malawi: Addressing evolving research priorities. Contemp Clin Trials 2016; 52:27-34. [PMID: 27836505 DOI: 10.1016/j.cct.2016.11.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 11/02/2016] [Accepted: 11/07/2016] [Indexed: 11/22/2022]
Abstract
Hormonal contraception is central in the prevention of unintended pregnancy; however there are concerns that certain methods may increase the risk of HIV acquisition and transmission. Hormonal contraceptives may modify the genital mucosa in several ways, however the mechanisms are incompletely understood. Few studies have examined genital HIV shedding prospectively before and after initiation of hormonal contraception. The effects of hormonal contraception on genital HIV shedding in the setting of antiretroviral therapy (ART) are also unknown. We designed a pilot clinical trial in which HIV-infected and uninfected women were randomized to either depot medroxyprogesterone acetate (DMPA) injectable or levonorgestrel (LNG) implant in Lilongwe, Malawi. The objectives were to: 1) assess the effect and compare the impact of type of progestin contraception (injectable versus implant) on HIV genital shedding among HIV-infected women, 2) assess the effect and compare the impact of type of progestin contraception on inflammatory/immune markers in the genital tract of both HIV-infected and uninfected women, and 3) assess the interaction of progestin contraception and ART by examining contraceptive efficacy and ART efficacy. An additional study aim was to determine the feasibility and need for a larger study of determinants of HIV transmissibility and acquisition. As injectable contraception is widely used in many parts of the world with high HIV prevalence, this study will provide important information in determining the need for and feasibility of a larger study to address these questions that can impact the lives of millions of women living with or at risk for HIV.
Collapse
|
73
|
Blithe DL. Pipeline for contraceptive development. Fertil Steril 2016; 106:1295-1302. [PMID: 27523300 PMCID: PMC5159203 DOI: 10.1016/j.fertnstert.2016.07.1115] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 07/14/2016] [Accepted: 07/21/2016] [Indexed: 11/16/2022]
Abstract
The high rates of unplanned pregnancy reflect an unmet need for effective contraceptive methods for women, especially for individuals with health risks such as obesity, diabetes, hypertension, and other conditions that may contraindicate use of an estrogen-containing product. Improvements in safety, user convenience, acceptability, and availability of products remain important goals of the contraceptive development program. Another important goal is to minimize the impact of the products on the environment. Development of new methods for male contraception has the potential to address many of these issues of safety for women who have contraindications to effective contraceptive methods but want to protect against pregnancy. It would also address a huge unmet need for men who want to control their fertility. Products under development for men would not introduce ecotoxic hormones into the water system.
Collapse
Affiliation(s)
- Diana L Blithe
- Contraception Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
| |
Collapse
|
74
|
Scarsi KK, Darin KM, Chappell CA, Nitz SM, Lamorde M. Drug-Drug Interactions, Effectiveness, and Safety of Hormonal Contraceptives in Women Living with HIV. Drug Saf 2016; 39:1053-1072. [PMID: 27562873 PMCID: PMC5048570 DOI: 10.1007/s40264-016-0452-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Family planning options, including hormonal contraceptives, are essential for improving reproductive health among the more than 17 million women living with HIV worldwide. For these women, prevention of unintended pregnancy decreases maternal and child mortality, as well as reduces the risk of perinatal HIV transmission. Similarly, treatment of HIV with antiretroviral therapy (ART) is essential for reducing morbidity and mortality among HIV-positive individuals, as well as preventing HIV transmission between sexual partners or from mother to child. Importantly, despite the benefits of hormonal contraceptives, barriers to effective family planning methods exist for HIV-positive women. Specifically, drug-drug interactions can occur between some antiretroviral medications and some hormonal contraceptives, which may influence both contraceptive efficacy and tolerability. In addition, safety concerns have been raised about the impact of hormonal contraceptives on HIV disease progression, tolerability, and the risk of female-to-male HIV transmission. This review article summarizes the potential for drug-drug interactions, tolerability, and contraceptive effectiveness when hormonal contraceptives are combined with ART. In addition, the evidence surrounding the influence of hormonal contraceptives on HIV transmission and HIV disease progression in women living with HIV are summarized.
Collapse
Affiliation(s)
- Kimberly K Scarsi
- Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, 986145 Nebraska Medical Center, Omaha, NE, 68198-6145, USA.
| | - Kristin M Darin
- Center for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Catherine A Chappell
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Stephanie M Nitz
- Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, 986145 Nebraska Medical Center, Omaha, NE, 68198-6145, USA
| | - Mohammed Lamorde
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| |
Collapse
|
75
|
|
76
|
Factors Associated with Hormonal and Intrauterine Contraceptive Use among HIV-Infected Men and Women in Lilongwe, Malawi: A Cross-Sectional Study. Infect Dis Obstet Gynecol 2016; 2016:5429316. [PMID: 27642245 PMCID: PMC5013202 DOI: 10.1155/2016/5429316] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 07/25/2016] [Indexed: 11/18/2022] Open
Abstract
Background. Understanding the factors associated with the use of hormonal and intrauterine contraception among HIV-infected men and women may lead to interventions that can help reduce high unintended pregnancy rates. Materials and Methods. This study is a subanalysis of a cross-sectional survey of 289 women and 241 men who were sexually active and HIV-infected and were attending HIV care visits in Lilongwe, Malawi. We estimated adjusted prevalence ratios (PRs) to evaluate factors associated with hormonal and intrauterine contraceptive use for men and women in separate models. Results and Discussion. 39.8% of women and 33.2% of men (p = 0.117) reported that they were using hormonal or intrauterine contraception at last intercourse. Having greater than 3 children was the only factor associated with hormonal and intrauterine contraceptive use among men. Among women, younger age, not wanting a pregnancy in 2 years, being with their partner for more than 4 years, and being able to make family planning decisions by themselves were associated with hormonal and intrauterine contraceptive use. Conclusions. The men and women in our study population differed in the factors associated with hormonal and intrauterine contraceptive use. Understanding these differences may help decrease unmet FP needs among HIV-infected men and women.
Collapse
|