Table 3.
Drug–drug interactions between hormonal contraception and antiretroviral therapy [6,63]
| Antiretroviral drug class | Specific antiretroviral | Interaction with hormonal contraception | Dose modification
|
|---|---|---|---|
| NRTIs | N/A | N/A | None |
| PIs | ATV (unboosted) | Increased ethinyl oestradiol
Increased norethindrone |
COC should contain no more than 30 μg ethinyl oestradiol or recommend alternative contraception method; no data on COC with <25 μg ethinyl oestradiol or progestins other than norethindrone or norgestimate |
| ATV/r | Reduced ethinyl oestradiol
Increased norgestimate |
COC should have minimum 35 μg ethinyl oestradiol | |
| ATV/c or DRV/c | Unknown interaction with COC | Recommend alternative contraception method or alternative ARV | |
| LPV/r | Reduced ethinyl oestradiol
Reduced norethindrone Increased etornogestrel (subdermal implant) Increased transdermal ethinyl oestradiol but reduced transdermal norelgestromin |
For COC: recommend alternative contraception method or alternative ARV
For subdermal implant: no adjustment required For transdermal patch: no adjustment required |
|
| Ritonavir-boosted PIs
other than ATV/r or LPV/r |
Reduced ethinyl oestradiol
Reduced norethindrone Unknown interaction with etornogestrel implant Unknown interaction with transdermal patch |
For COC: recommend alternative contraception method or alternative ARV
For subdermal implant or transdermal patch: recommend alternative contraception method or alternative ARV |
|
| NNRTIs | EFV | No effect on ethinyl oestradiol
Reduced levonorgestrel Reduced norelgestromin |
For COC: use additional or alternative contraception
For subdermal implant: use additional or alternative contraception |
| Reduced etornogestrel (subdermal implant) | |||
| NVP | Reduced ethinyl oestradiol
Reduced norethindrone No effect on DMPA |
For COC: use alternative or additional contraception
For DMPA: no adjustment needed |
|
| RPV and ETR | Increased ethinyl oestradiol
No change to norethindrone |
For COC: no adjustment needed | |
| INSTIs | EVG/c | Reduced ethinyl oestradiol
Increased norgestimate |
Weigh risks and benefits of increased progestin; consider alternative contraception methods |
| RAL and DTG | No change for ethinyl oestradiol or norgestimate | For COC: no adjustment needed |
NRTIs: nucleoside reverse-transcriptase inhibitors; ATV: atazanavir; PIs: protease inhibitors; ATV/r: ritonavir-boosted atazanavir; COC: combined oral contraception; DRV/r: ritonavir-boosted-darunavir; ARV: antiretroviral; LPV/r: ritonavir-boosted-lopinavir; NNRTIs: non-nucleoside reverse-transcriptase inhibitors; EFV: efavirenz; NVP: nevirapine; DMPA: depo-medroxyprogesterone acetate; RPV: rilpivirine; ETR: etravirine; INSTIs: integrase strand transfer inhibitors; EVG/c: cobicistat-boosted elvitegravir; RAL: raltegravir; DTG: dolutegravir.