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The following is a summary of “Drug-drug interactions between antiretrovirals and hormonal contraception: An updated systematic review,” published in the October 2024 issue of Obstetrics and Gynecology by Todd et al.  

Researchers conducted a retrospective study to consolidate and refresh knowledge about drug-drug interactions (DDIs) between antiretrovirals (ARVs) and hormonal contraceptives (HCs). 

They analyzed 49 articles, classifying the outcomes into clinical, ARV, or HC pharmacokinetic (PK) categories. Clinical outcomes were mentioned in 39 articles, ARV outcomes in 25, and HC PK outcomes in 30. Some articles reported outcomes across multiple categories. 

The results showed 18 studies examining DDIs involving efavirenz and progestin implants, emergency contraception, or combined hormonal intravaginal rings; 15 reported increased pregnancy rates, ovulation (based on luteal progesterone levels), or decreased progestin PK values, CYP2B6 single nucleotide polymorphisms intensified the DDIs in 5 studies. Only 1 cohort study noted a twofold increase in bone density loss with the combined use of depot medroxyprogesterone acetate (DMPA) and tenofovir disoproxil fumarate (TDF)-based antiretroviral therapy (ART) compared to TDF alone. No other studies found DDI impacting clinical outcomes. AEs related to ARV-HC use were infrequent, with none exceeding Grade 2 severity. The evidence quality was generally moderate, with common limitations including differences between treatment and control groups, insufficient confounder control, and attrition bias. 

Investigators concluded that longer-term studies on bone health and consideration of alternate combinations were warranted due to TDF-DMPA DDIs, while efavirenz-based ART clients should continue receiving counseling on relative risks to facilitate informed method choice. 

Source: sciencedirect.com/science/article/pii/S0010782424001628