Potential risk of drug–drug interactions with hormonal contraceptives and antiretrovirals: prevalence in women living with HIV

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Abstract

Background: Family planning services are vital for women living with HIV (WLH); however, the use of concomitant antiretroviral therapy (ART) and hormonal contraceptives (HCs) may pose challenges due to the risk of potential drug–drug interactions (DDIs). The objectives of this study were to assess ART and HC use among WLH and quantify the frequency of potential DDIs between ART and HCs.

Methods: This was a retrospective, observational, cohort study of WLH aged 18–55 years, prescribed ART, with at least one clinic visit from January 1, 2010 to April 30, 2014. Potential DDIs between HCs and ART were assessed using the University of Liverpool HIV Drug Interactions website (www.hiv-druginteractions.org) and categorized as ‘weak potential interaction,’ ‘potential interaction,’ or ‘do not co-administer.’

Results: Overall, a contraceptive method was reported in 167 (54%) of the 309 women included in the study. Of those using contraception, 73 (43.7%) reported using HCs, which was most frequently a progestin intrauterine device (n=43), progestin injection (n=17), or combination oral contraceptive pills (n=9). Out of a total of 449 ART regimens, a potential DDI was identified in 21 of 115 (18.3%) ART–HC combinations from 19 women using ART and HCs. Atazanavir/ritonavir was the most common potentially interacting ART (10, 47.6%); for HCs, these were combination oral contraceptive pills (16, 76.2%) and progestin implants (2, 9.5%).

Conclusion: In this cohort, one-quarter of WLH on ART–HCs had a potential DDI. Future studies should investigate the impact of DDIs on unintended pregnancies, the side effects of DDIs, and the effects of HC DDIs on ART concentrations.

Keywords: AIDS, antiretroviral agents, cisgender women, drug interactions, HIV, hormonal contraception, reproductive health, women.

Citation: Murray MM, Jensen A, Cieslik T, Cohn SE. Potential risk of drug–drug interactions with hormonal contraceptives and antiretrovirals: prevalence in women living with HIV. Drugs in Context 2020; 9: 2020-5-9. DOI: 10.7573/dic.2020-5-9

Contributions: MM and SC contributed to the design and implementation of the research; MM and AJ to the analysis of the results; MM, SC, and TC to the interpretation of the results. All authors contributed to the writing of the manuscript and approved the final version for submission. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article and take responsibility for the integrity of the work as a whole.

Disclosure and potential conflicts of interest: MM is a speaker for Merck. All other authors report no conflicts of interest. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2020/07/dic.2020-5-9-COI.pdf

Acknowledgements: The authors would like to acknowledge Kristen Darin, PharmD for her contributions to the success of this project. These results were previously presented as Poster Presentation #2238 during ID Week in San Diego, CA, October 4–7, 2017.

Funding declaration: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Copyright: Copyright © 2020 Murray MM, Jensen A, Cieslik T, Cohn SE. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0 which allows anyone to copy, distribute, and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2020 Murray MM, Jensen A, Cieslik T, Cohn SE. https://doi.org/10.7573/dic.2020-5-9. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/potential-risk-of-drug-drug-interactions-with-hormonal-contraceptives-and-antiretrovirals:-prevalence-in-women-living-with-hiv

Correspondence: Milena Murray, Midwestern University Chicago College of Pharmacy, Department of Pharmacy Practice, 555 31st St., Downers Grove, IL, 60515, USA. mmurra@midwestern.edu

Provenance: Invited; externally peer reviewed.

Submitted: 21 May 2020; Peer review comments to author: 17 June 2020; Revised manuscript received: 15 July 2020; Accepted: 15 July 2020; Publication date: 5 August 2020.

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