Examining Drug-Drug Interactions in Women With HIV: ART and Hormonal Contraception

IUD and oral contraception pills
IUD and oral contraception pills
Examining the barriers to co-use of hormonal contraceptives and antiretroviral therapy in women with HIV.
This article is part of Infectious Disease Advisor’s coverage of IDWeek 2017™, which took place in San Diego, CA. Our staff will be reporting on the latest breaking research and clinical advances in infectious diseases. Check back regularly for highlights from IDWeek 2017.

Women with HIV who use hormonal contraceptives while undergoing antiretroviral therapy (ART) were at higher risk for drug-drug interactions, according to research presented at IDWeek 2017, held in San Diego, California.

Milena M. McLaughlin, PharmD, MSc, from the Midwestern University Chicago College of Pharmacy in Illinois, and colleagues, conducted a retrospective chart review of 317 women (median age: 37 [IQR: 28-46]; 54.3% African American and 88.5% non-Hispanic) with HIV who visited the Northwestern Infectious Disease Center from January 2010 through April 2014. Dr McLaughlin and colleagues aimed to identify potential drug-drug interactions in women with HIV who used hormonal contraception.

Researchers noted a median of 8 clinic visits (interquartile range [IQR]: 5-13) and a total of 438 ART regimens (64.4% ritonavir-boosted PI [protease inhibitor]-based, 18.3% non-nucleoside reverse transcriptase inhibitors [NNRTI]-based, 7.1% integrase strand transfer inhibitor [INSTI]-based; 10.3% other). More than 50% (53.3%) of patients reported use of hormonal contraceptives; most women used a progestin intrauterine device, an injection, or a combination oral contraceptive pills (57.3%, 22.7%, and 12%, respectively).

Interactions were most frequently recorded in patients taking ritonavir-boosted PI ART, while the most common contraception with interactions was the progestin intrauterine device, followed by oral contraceptive pills (83.8%, 68.9%, and 23%, respectively).

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Moderate severity potential drug-drug interactions were identified in 74 of 113 ART-hormonal contraceptive combinations, a representation of 76% of all women using ART and contraception.

“Approximately one-third of [women living with HIV] using any contraceptive in our clinic had a potential [drug-drug interaction] with ART,” Dr McLaughlin and colleagues concluded. “The clinical implications need to be further explored.”

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McLaughlin MM, Jensen A, Cohn S, Darin K. Prevalence of drug-drug interactions with hormonal contraceptives and antiretrovirals in women living with HIV. Presented at: IDWeek 2017; October 4-8, 2017; San Diego, CA. Abstract 2238.