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Drug–Drug Interactions, Effectiveness, and Safety of Hormonal Contraceptives in Women Living with HIV

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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.

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Authors and Affiliations

  1. Department of Pharmacy Practice, College of Pharmacy, University of Nebraska Medical Center, 986145 Nebraska Medical Center, Omaha, NE, 68198-6145, USA

    Kimberly K. Scarsi & Stephanie M. Nitz

  2. Center for Global Health, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Kristin M. Darin

  3. Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA, USA

    Catherine A. Chappell

  4. Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda

    Mohammed Lamorde

Authors
  1. Kimberly K. Scarsi
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  2. Kristin M. Darin
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  3. Catherine A. Chappell
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  4. Stephanie M. Nitz
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  5. Mohammed Lamorde
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Correspondence to Kimberly K. Scarsi.

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Funding

We acknowledge support from the following grants from the National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development [Grant Numbers 1R01HD085887 (Kimberly Scarsi) and K12HD043441 (Catherine Chappell)]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Conflict of interest

Kimberly Scarsi, Kristin Darin, Catherine Chappell, Stephanie Nitz, and Mohammed Lamorde have no conflicts of interest that are directly relevant to this content.

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Scarsi, K.K., Darin, K.M., Chappell, C.A. et al. Drug–Drug Interactions, Effectiveness, and Safety of Hormonal Contraceptives in Women Living with HIV. Drug Saf 39, 1053–1072 (2016). https://doi.org/10.1007/s40264-016-0452-7

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