Bleeding patterns of HIV-infected women using an etonogestrel-releasing contraceptive implant and efavirenz-based or lopinavir/ritonavir-based antiretroviral therapy

Author(s)

Ragazini, Conrado S. ; Bahamondes, Maria Valeria ; Rocha Prandini, Tatiana R. ; Brito, Milena Bastos ; Amaral, Eliana ; Bahamondes, Luis ; Duarte, Geraldo ; Quintana, Silvana Maria ; Ferriani, Rui Alberto ; Vieira, Carolina Sales

• Document type: Journal article
• Source: EUROPEAN JOURNAL OF CONTRACEPTION AND REPRODUCTIVE HEALTH CARE; v. 21, n. 4, p. 285-289, AUG 2016.
• Web of Science Citations: 2

Abstract

Objectives: The use of progestogen-only contraceptives may cause a change in bleeding pattern, which is a common cause of discontinuation of these methods. Co-administration with some antiretroviral therapies (ART) changes the bioavailability of the etonogestrel (ENG)-releasing contraceptive implant, possibly affecting the bleeding pattern. Bleeding patterns were evaluated in HIV-positive users of the ENG implant co-administered with two common ART regimens.Methods: Forty-five HIV-positive women who wished to use an ENG implant were included in this study: 15 had received zidovudine/lamivudine (AZT/3TC) + lopinavir/ritonavir (LPV/r) for 3 months (LPV/r-based ART group), 15 had received AZT/3TC+efavirenz (EFV) for 3 months (EFV-based ART group), and 15 had not received ART (non-ART group). Bleeding patterns were evaluated at 3 and 6 months after implant placement using a standard bleeding calendar.Results: Amenorrhoea and infrequent bleeding rates were higher in the LPV/r-based ART group (50% and 36%, respectively) than in the other groups (non-ART group, 36% and 29%, respectively; EFV-based ART group, 7% and 14.5%, respectively; p=0.01). The EFV-based ART group more frequently had regular bleeding (71.5%) compared with the other groups (LPV/r-based ART group, 7%; non-ART group, 21%; p=0.01). The proportions of women with frequent and prolonged bleeding were similar (p>0.05) in the three groups.Conclusions: The co-administration of EFV-based or LPV/r-based ART with the ENG implant affected the expected bleeding patterns during use of the implant, although unfavourable bleeding (frequent and prolonged) was not associated with the medications under evaluation. (AU)