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Table 1 PK studies assessing the interaction between HC and ARVs

From: Contraception in HIV-positive female adolescents

PK studies assessing the interaction between DMPA and ARVs
  Author n ARV Hormones Outcome
1. Cohn, Watts et al, 2006 (43, 44),
pharma sponsored partly
70 HIV+,
22-46 y
NFV (n = 21)
EFV (n = 17)
NVP (n = 16)
NRTI only (n = 16)
DMPA, single dose ↓ NFV
↑ NVP
EFV - no significant change
DMPA - no significant change
Progesterone < 1.6 ng/ml, no ovulation
Conclusion: DMPA is an effective contraceptive method for HIV+ women on ARVs in the study
2. Nanda et al., 2007 (45) 30 HIV+,
19-40 y
AZT+3TC+EFV DMPA, single dose ARV levels - not done
DMPA - no significant change
Progesterone - only in one woman (control group) > 5 ng/ml, might indicate ovulation
Conclusion: DMPA is an effective contraceptive method for HIV+ women on triple ARV regime in the study
PK studies assessing the interaction between EE, progestins and NNRTIs and NtNRTI
1. Mildvan et al., 2002 (46),
pharma sponsored
10 HIV+,
26-47 y
NVP 200 mg BID 0.035 mg EE/1.0 mg NET, single dose ↓ 29% AUC of EE
↓ 18% AUC of NET
NVP - no significant change
Conclusion: COC should not be primary method for contraception in HIV+ women on NVP
2. Joshi et al., 1998 (47),
pharma sponsored
13 HIV- EFV 400 mg OD, 7 days 0.05 mg EE, single dose ↑ 37% AUC of EE
EFV - no significant change
Conclusion: no decrease in EE levels when co-administered with EFV
3. Sevinsky et al., 2008 (48),
pharma sponsored
28 HIV-,
18-42 y
EFV 600 mg OD, 14 days EE/NGM, 3 cycles EE - no significant change
↓ 64% AUC of NGMN
↓ 83% AUC of LNG
EFV - no significant change
Progesterone < 1.25 ng/ml
Conclusion: need of reliable barrier contraception when taking COC with EFV
4. Scholler-Guyera et al., 2009 (49),
pharma sponsored
30 HIV-, 18-45 y ETR 200 mg BID 0.035 mg EE/1.0 mg NET, 3 cycles ↑ 22% AUC of EE
↓ 5% AUC of NET
↑ ETR
Conclusion: no compromise in contraceptive effect
5. Kearney et al., 2009 (50),
pharma sponsored
20 HIV-,
19-45 y
TDF 300 mg OD EE/NGM, 3 cycles EE - no significant change
NGM - no significant change
TDF - no significant change
Conclusion: TDF does not alter PK of EE and NGM
PK studies assessing the interaction between EE, progestins and PIs
1. Ouellet et al., 1998(51),
pharma sponsored
23 HIV-, 18-45 y Ritonavir
500 mg BID
0.05 mg EE, single dose ↓41% AUC of EE
Conclusion: use an alternative contraceptive method when ritonavir is administered
2. Frohlich et al., 2004(54),
pharma sponsored partly
8 HIV-,
23.8 y
Saquinavir single dose 0.03 mg EE
0.075 mg gestoden
SQV - no significant change
Conclusion: COC does not alter single dose saquinavir
3. Tacket et al., 2003 (55),
pharma sponsored
22 HIV- ATZ 400 mg 0.035 mg EE/1.0 mg NET ↑ 48% AUC of EE
↑110% AUC of NET
Conclusion: no compromise in contraceptive effect, no dose adjustment needed
4. Sekar et al., 2008 (52),
pharma sponsored
19 HIV- DRV/r 600 mg/100 mg BID 0.035 mg EE/1.0 mg NET, 2 cycles ↓44% AUC of EE
↓14% AUC of NET
Conclusion: use an alternative method
5. Vogler et al., 2010 (53) 8 HIV+ with LPV/r, 24 HIV+ w/o LPV/r LPV/r
400 mg/100 mg
0.035 mg EE/1.0 mg NET, single dose EE/NGMN skin patch for 3 w ↓45% AUC of patch EE
↑83% AUC of patch NGNM
↓55% AUC of pill EE
↓19% AUC of LPV with patch
↓23% AUC of RTV with patch
Progesterone < 2.88 ng/ml, no ovulation
Conclusion: PK of EE/NGMN significantly altered, but clinical effect probably not affected
  1. NFV = nelfinavir, EFV = efavirenz, NVP = nevirapine, NRTI = nucleoside reverse transcriptase inhibitor, AZT = zidovudine, 3TC = lamivudine, DMPA = depot medroxyprogesterone acetate, EE = ethinyl estradiol, NET = norethindrone, NGM = norgestimate, NGMN = norelgestromin, LNG = levonorgestrel, ETR = etravirine, TDF = tenofovir disoproxil fumarate, RTV = ritonavir, ATZ = atazanavir, SQV = saquinavir, DRV/r = ritonavir boosted darunavir, LPV/r = ritonavir boosted lopinavir, COC = combined oral contraceptive, PK = pharmacokinetic, AUC = area under the curve, ↑ = increase, ↓decrease, OD = once daily, BID = twice daily, pharma sponsored = the study is financed by a pharmaceutical company (manufacturer of drugs under study)