Special Considerations in the Management of Women With HIV, Including Management of Conception and Pregnancy

  • Author: Kristine Patterson, MD (More Info)
  • Section Editor: Judith S. Currier, MD, MSc
  • Editors in Chief: Daniel R. Kuritzkes, MD; Joseph J. Eron, Jr., MD
  • Last Reviewed: 8/30/19 (What's New)

Supporting Assets

Table 1 | Table 2 | Table 3 | Table 4

Table 1. Effects of Coadministration of Antiretroviral Therapy and Combined Oral Contraceptives

Antiretroviral Agent

Overall Effect or Recommendation

NRTIs

No effect

NNRTIs

 

Progestin levels markedly decreased

Effectiveness of emergency contraception may be diminished

Barrier method should be used in addition to this method

No dose adjustment needed

No additional contraceptive protection needed

No dose adjustment needed

No additional contraceptive protection needed

No dose adjustment needed

No additional contraceptive protection needed

PIs

 

COC should contain no more than 30 µg of ethinyl estradiol

No additional contraceptive protection needed

Decreases in ethinyl estradiol and marked increases in drospirenone progestin

Contraindicated with drospirenone-containing hormonal contraceptive due to potential for hyperkalemia

Consider alternative or additional contraceptive method

Ritonavir inhibits CYP3A4, which may increase contraceptive hormone levels

No additional contraceptive protection needed

Decreases in ethinyl estradiol and marked increases in drospirenone progestin

Clinical monitoring recommended with drospirenone-containing hormonal contraceptive due to potential for hyperkalemia

Consider alternative or additional contraceptive method

Small decrease in progestin levels

Additional or alternative method recommended

Reduced amprenavir levels when fosamprenavir coadministered with ethinyl estradiol/norethindrone; may lead to loss of virologic response

Use alternative contraceptive method

Additional or alternative method recommended

Small increases in ethinyl estradiol and progestin

No additional contraceptive protection needed

Decreases in ethinyl estradiol and progestin

No additional contraceptive protection needed

Decrease in ethinyl estradiol

Additional or alternative method recommended

Decrease in ethinyl estradiol

Additional or alternative method recommended

Decrease in ethinyl estradiol

Additional or alternative method recommended

Integrase Inhibitors

 

No additional contraceptive protection needed

  • Cobicistat/elvitegravir

Ethinyl estradiol levels decreased

Progestin levels increased

No additional contraceptive protection needed

No additional contraceptive protection needed

CCR5 Antagonist

 

No additional contraceptive protection needed

COC, combined oral contraceptives; DMPA, depot medroxyprogesterone acetate.

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Keywords: Women