Prevalence of Drug–Drug Interactions with Hormonal Contraceptives and Antiretrovirals in Women Living with HIV

BACKGROUND: The use of contraception for family planning is critically important for women living with HIV (WLH), but barriers to co-use of hormonal contraceptives (HC) and antiretroviral therapy (ART) exist due to drug-drug interaction (DDI) potential. The objective of this study was to describe the type and frequency of HC and ART used among WLH and to identify the prevalence and severity of DDI potential between HC and ART. METHODS: This was a retrospective chart review of WLH, receiving ART, who were 18–60 years old, and had at least one clinic visit at the Northwestern Infectious Disease Center from January 1, 2010 to April 30, 2014. Electronic medical charts were reviewed to assess demographics and history of contraceptive and ART use. For each combined HC and ART regimen, DDI potential and severity (major, moderate or minor) was assessed using the University of Liverpool HIV Drug Interactions website (www.hiv-druginteractions.org). RESULTS: During the study period, 317 women had a median of 8 clinic visits (interquartile range (IQR) 5–13) and received a total of 438 ART regimens: ritonavir-boosted PI- (282, 64.4%), NNRTI- (80, 18.3%), other- (45, 10.3%), INSTI-based (31, 7.1%). The cohort had a median age of 37 years (IQR 28–46); 170 (54.3%) were African American and 277 (88.5%) were non-Hispanic. The use of any contraceptive method was reported in 169 (53.3%) women, of which 75 (44.4%) reported using HC, mostly commonly a progestin intrauterine device (43, 57.3%) or injection (17, 22.7%), or combination oral contraceptive pill (OCP; 9, 12%). A potential DDI (all moderate severity) was identified in 74 of 113 ART-HC-regimen combinations, representing 57 (76%) women using ART and HC. Ritonavir-boosted PIs were the ART most frequently implicated in a potential DDI (62, 83.8%); for HC, this was the progestin intrauterine device (51, 68.9%) and OCP (17, 23%). CONCLUSION: Approximately one-third of WLH using any contraceptive in our clinic had a potential DDI with ART. Though frequently used and implicated, the progestin IUD is unlikely to result in a clinically significant DDI with ART, but confirmation of this assumption is warranted. Relative to its frequency of use, there was high prevalence of potential OCP-ART DDI; the clinical implications need to be further explored. DISCLOSURES: All authors: No reported disclosures.