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

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.

Chinese abstract

目的：用只含有孕激素的避孕药可能会引起出血模式的变化, 这是这些方法不能继续应用的一个常见原因。联合应用一些抗逆转录病毒疗法（ART）的制剂可改变释放依托孕烯（ENG）的避孕植入剂的生物利用度, 进而影响出血模式。评估HIV阳性应用ENG植入剂联合两种常见的抗逆转录病毒制剂患者的出血模式。

方法：包括45名HIV阳性希望应用ENG避孕植入剂的的女性患者：15名女性接受齐多夫定/拉米夫定(AZT/3TC) 及洛匹那韦/利托那韦（LPV/R）治疗≥3个月（LPV/R的ART组）, 15名接受AZT/3TC及依法韦仑（EFV）治疗≥3个月（EFV的ART组）, 还有15名未接受ART（非ART组）。在植入剂植入后3个月和6个月用标准的出血日历评估出血模式。 结果：闭经和罕见的出血率在LPV/R-ART组（分别为50%和36%）高于其他组（非ART组分别为36%和29%；EFV的ART组别为7%和14.5%, P = 0.01）。EFV的ART组比其他组规律出血（71.5%）更常见, （LPV/R-ART组, 7%；非ART组, 21%；P = 0.01）。频率和出血时间延长在三组中的比例相似（P > 0.05）。

结论：ENG避孕植入剂联合EFV或LPV/R-ART用药影响植入剂预期的出血模式, 虽然不利的出血（频繁和时间长）与评估的药物无关。

Keywords:

• Bleeding pattern
• contraceptive
• etonogestrel
• HIV

Disclosure statement

CSV, MBB and LB give occasional lectures for MSD and Bayer.

Funding information

The study was co-funded by Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) (grant no. 2009/53147-3) and the Brazilian Council of Science and Technology (grant no. 479795/2010-0).