Document Detail

Efavirenz, in contrast to nevirapine, is associated with unfavorable progesterone and antiretroviral levels when coadministered with combined oral contraceptives.
MedLine Citation:
PMID:  23187949     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Effective contraception has been widely promoted for HIV-positive women. However, there are limited data on the interactions between combined hormonal contraceptives and nonnucleoside reverse transcriptase inhibitors .
METHODS: This study assessed the steady-state contraceptive effectiveness and safety of combined oral contraceptive (COC) containing 0.150 mg desogestrel /0.030 mg ethinyl estradiol with either nevirapine (NVP) or efavirenz (EFV) in 34 HIV-positive women. The targeted level for contraceptive effectiveness was endogenous progesterone level < 3.0 ng/mL. We measured NVP/EFV plasma concentrations 12 hours after administration (C12) with and without COC. The desired therapeutic levels were >3.1 mg/L for NVP and 1.0-4.0 mg/L for EFV, respectively.
RESULTS: All 18 subjects in the NVP group had serum progesterone <1.0 ng/mL. Four of 16 subjects (25%) in the EFV group had serum progesterone >1.0 ng/mL, including 3 subjects with >3.0 ng/mL (might indicate ovulation). The difference in progesterone levels between the 2 groups was statistically significant (P = 0.04). The median C12 of NVP increased insignificantly by 17% with COC; the median C12 of EFV decreased significantly (P = 0.02) by 22%. In 3 of 16 subjects (19%) in the EFV group, C12 of EFV dropped below 1.0 mg/L.
CONCLUSIONS: In contrast to NVP, coadministrating desogestrel/ethinyl estradiol containing COC with EFV was associated with unfavorable progesterone and antiretroviral levels. Our results suggest that NVP may be superior to EFV when used with COC in HIV-positive women.
Nadia Kancheva Landolt; Nittaya Phanuphak; Sasiwimol Ubolyam; Suteeraporn Pinyakorn; Rosalin Kriengsinyot; Jennisa Ahluwalia; Parawee Thongpaeng; Meena Gorowara; Narukjaporn Thammajaruk; Surasith Chaithongwongwatthana; Joep M A Lange; Jintanat Ananworanich
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of acquired immune deficiency syndromes (1999)     Volume:  62     ISSN:  1944-7884     ISO Abbreviation:  J. Acquir. Immune Defic. Syndr.     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-06-13     Completed Date:  2013-10-18     Revised Date:  2014-02-06    
Medline Journal Info:
Nlm Unique ID:  100892005     Medline TA:  J Acquir Immune Defic Syndr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  534-9     Citation Subset:  IM; X    
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MeSH Terms
Anti-HIV Agents / administration & dosage,  adverse effects,  blood
Benzoxazines / administration & dosage*,  blood
Contraceptives, Oral, Synthetic / administration & dosage*
Desogestrel / administration & dosage
Drug Interactions
Ethinyl Estradiol / administration & dosage
HIV / isolation & purification
HIV Infections / blood*,  drug therapy*
Logistic Models
Middle Aged
Nevirapine / administration & dosage*,  adverse effects,  blood
Progesterone / blood*
Prospective Studies
Young Adult
Reg. No./Substance:
0/Anti-HIV Agents; 0/Benzoxazines; 0/Contraceptives, Oral, Synthetic; 423D2T571U/Ethinyl Estradiol; 4G7DS2Q64Y/Progesterone; 81K9V7M3A3/Desogestrel; 99DK7FVK1H/Nevirapine; JE6H2O27P8/efavirenz

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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