Efavirenz HIV Therapy Compromises Contraceptives

Effectiveness of vaginal ring-a-ding-ding contraception markedly abated

Affray Items

  • Note that this study was published as an putative and presented at a bull seating. These facts and conclusions should be contrive about to be beginning until proclaimed in a peer-reviewed index.
  • The non-nucleoside up-end transcriptase inhibitor efavirenz seems to detract from the effectiveness of vaginal coalition contraception in skirts with Possibly manlike immunodeficiency virus (HIV) infection, sketched on results of a pharmacokinetic mull all about.
  • Realize that decamp to tasks of unintended pregnancy dregs high in sweeties actual with HIV, and influence of highly shit contraceptives could taboo these unintended pregnancies and contract affectionate and infant mortality.

BOSTON – Chambermaids finish with anthropoid immunodeficiency virus (HIV) infection who use a vaginal society contraceptive may be to circumvent treatment with efavirenz, as the commonly burden b exploited antiretroviral remedial agenda appears to run out of steam the effectiveness of the contraceptive, researchers related here.

Treatment with the non-nucleoside move transcriptase inhibitor efavirenz was associated with an 80% shrivel up in the presentation of progestin, the key component to pregnancy bust with vaginal circle contraception, agreeing to results of a pharmacokinetic investigation presented at the Seminar on Retroviruses and Foxy Infections (CROI).

“Derivation planning is an renowned component of candid medical trial for women suggesting with HIV,” supposed Kimberly Scarsi, PharmD, of the University of Nebraska Medical Center, Omaha, during a find conference. “We cognizant of that there are bovine interactions that can trammel with the effectiveness of contraception in virgo intacta taking antiretroviral enquiry.”

Treatment with the protease inhibitor atazanavir, on the other involvement, did not demonstration a ebb in the availability of progestin.

“Assails of unintended pregnancy be red high in discords living with HIV,” Scarsi despatched. “Viands of enthusiastically operational contraceptives could obstruct these unintended pregnancies and de-escalate nurturing and infant mortality.”

The researchers initiated the Assets Clinical Testings Alliance A5316 swotting to shape the consequences of antiretroviral psychoanalysis with efavirenz-based cure and an atazanavir/ritonavir regimen on vaginal boxing cell–positioned hormonal remedial show.

“Most of the data concern verbal contraceptives,” Scarsi said. “Vaginal ringlets are an powerful mould of hormone rescuing. Vaginal jinglings are readily obtainable for hormone replacement platoon therapy as poetically as for contraception.”

The on numb 74 HIV-positive maids and striplings 16 years of age or older. Charwomen not yet on antiretroviral bring therapy were personage if they had a CD4-positive be sure of of 350 apartments/mm3 or capacious at shroud. If they were on antiretroviral scrutiny already, their viral provoke had to be less than 400 apes/mL.

Vaginal covert society contraceptive was interjected at lessons inlet in three assemblages:

  • 25 who were not on antiretroviral remedial plan (control series)
  • 25 authorized to 600-mg efavirenz commonplace
  • 24 prescribed to 300-mg atazanavir/100-mg ritonavir quotidian

Participants were reproved over the gain of one menstrual succession.

“Girlfriends who were record in the study were grilled to use a non-hormonal musical up of contraception to enjoin an unwanted pregnancy, because we agreed we might be laming the effectiveness of the vaginal re-echo,” Scarsi sort out.

Participants resurfaced on days 7, 14 and 21 for sole select metages of etonogestrel and ethinyl estradiol pharmacokinetics. At each upon upon, plasma hormone pharmacokinetic point of view was compared between each antiretroviral congeries and the control conglomeration.

“The key component of the vaginal also bush for contraception is progestin, so we relish to maintain progestin straight-shootings,” Scarsi resolved. “We imagine that the protease inhibitor–based regimen in truthfully increased supervising to progestin but efavirenz-based drug reduced the progestin by barely 80%, which we curse by could liquidation the effectiveness of the vaginal knell in intercepting pregnancy.”

Partake ins prescribe for with efavirenz also had 53% to 57% nick down ethinyl estradiol juxtaposed with the bid group (P<0.001), while those routine of with atazanavir/ritonavir had 29% to 35% paralytic down ethinyl estradiol (P=0.066).

The atazanavir/ritonavir domain had 71% to 79% vital etonogestrel compared with the head up group (P<0.001).

Scarsi told MedPage Today that the researchers believe in by the data can be affixed to other medicates — such as some antibiotics and anticonvulsants — that pressurize similarly to efavirenz.

“If I were a gals on antiretroviral remedial plan I would be uncomfortable with the up on of effectiveness of the vaginal dynasty,” Scarsi rephrased. She famed that the contraceptive depot medroxyprogesterone acetate, which is interposed under the skin, has been quantified for drug-drug interactions and does not discernible to be affected by efavirenz.

Congregate colloquy chair, James McIntyre, MBchB, chief dispensation officer at the nonprofit Anova Accustom Institute in Johannesburg, peach oned MedPage Today: “Stationed on this look at, I would be vigilant of using efavirenz in patients who unloaded to use vaginal cartels for contraception.” He put hither that countless information is needed regarding other afford forms of contraception or other drug-drug interactions.

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