Women taking various forms of hormonal contraceptives can likely combine them safely with antiretrovirals (ARVs), whether as HIV treatment or in the form of Truvada (tenofovir disoproxil fumarate/emtricitabine) as pre-exposure prophylaxis (PrEP) against the virus. The one ARV that may be problematic to combine with such forms of birth control is Sustiva (efavirenz), which is included in Atripla (efavirenz/tenofovir disoproxil fumarate/emtricitabine).
Publishing their findings in the journal AIDS, researchers conducted a systematic review of published literature through September 2015, ultimately reviewing 50 reports from 46 studies of women using hormonal contraceptives and ARVs at the same time, whether for treatment or as PrEP. They looked for changes in the effectiveness, toxicity and pharmacokinetics (how the drugs are metabolized, including changes in drug levels in the body) of each treatment.
The researchers found that most ARVs, whether used as treatment or prevention, have limited drug-drug interactions with hormonal contraceptives. The standout exception was Sustiva. The limited data available suggest that Sustiva, and by extension Atripla, may compromise the effectiveness of hormonal birth control, with the exception of depot medroxyprogesterone acetate. Any drug-drug interactions with Sustiva notwithstanding, birth control implants remain very effective when paired with the drug.
Hormonal contraceptives do not apparently affect plasma levels or the effectiveness of ARVs.
According to the available data, taking PrEP does not reduce the effectiveness of hormonal contraceptives.
The researchers concluded: “Women taking antiretrovirals, for treatment or prevention, should not be denied access to the full range of hormonal contraceptive options but should be counseled on the expected rates of unplanned pregnancy associated with all contraceptive methods, in order to make their own informed choices.”
To read the study, click here.