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Efavirenz, in Contrast to Nevirapine, is Associated With Unfavorable Progesterone and Antiretroviral Levels When Coadministered With Combined Oral Contraceptives

Landolt, Nadia Kancheva MD*; Phanuphak, Nittaya MD†,‡; Ubolyam, Sasiwimol MSc*; Pinyakorn, Suteeraporn MSc*; Kriengsinyot, Rosalin; Ahluwalia, Jennisa RN*; Thongpaeng, Parawee RN*; Gorowara, Meena MSc*; Thammajaruk, Narukjaporn MSc*; Chaithongwongwatthana, Surasith MD§; Lange, Joep M. A. MD, PhD; Ananworanich, Jintanat MD, PhD*,†,‡,§

JAIDS Journal of Acquired Immune Deficiency Syndromes: April 15th, 2013 - Volume 62 - Issue 5 - p 534–539
doi: 10.1097/QAI.0b013e31827e8f98
Clinical Science

Background: Effective contraception has been widely promoted for HIV-positive women. However, there are limited data on the interactions between combined hormonal contraceptives and nonnucleoside reverse transcriptase inhibitors .

Methods: This study assessed the steady-state contraceptive effectiveness and safety of combined oral contraceptive (COC) containing 0.150 mg desogestrel /0.030 mg ethinyl estradiol with either nevirapine (NVP) or efavirenz (EFV) in 34 HIV-positive women. The targeted level for contraceptive effectiveness was endogenous progesterone level < 3.0 ng/mL. We measured NVP/EFV plasma concentrations 12 hours after administration (C12) with and without COC. The desired therapeutic levels were >3.1 mg/L for NVP and 1.0–4.0 mg/L for EFV, respectively.

Results: All 18 subjects in the NVP group had serum progesterone <1.0 ng/mL. Four of 16 subjects (25%) in the EFV group had serum progesterone >1.0 ng/mL, including 3 subjects with >3.0 ng/mL (might indicate ovulation). The difference in progesterone levels between the 2 groups was statistically significant (P = 0.04). The median C12 of NVP increased insignificantly by 17% with COC; the median C12 of EFV decreased significantly (P = 0.02) by 22%. In 3 of 16 subjects (19%) in the EFV group, C12 of EFV dropped below 1.0 mg/L.

Conclusions: In contrast to NVP, coadministrating desogestrel/ethinyl estradiol containing COC with EFV was associated with unfavorable progesterone and antiretroviral levels. Our results suggest that NVP may be superior to EFV when used with COC in HIV-positive women.

*The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Bangkok, Thailand

The Thai Red Cross AIDS Research Centre, Bangkok, Thailand

SEARCH, Bangkok, Thailand

§Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands.

Correspondence to: Nadia Kancheva Landolt, MD, The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Centre, 104 Rajdumri Road, Pathumwan, Bangkok, Thailand 10330 (e-mail:

Supported by the Cluster Ratchadapisek Sompotch Endowment Fund, Chulalongkorn University [Grant Number: RA53/54(1)] and HIV-NAT.

The authors have no conflicts of interest to disclose.

Received September 07, 2012

Accepted November 16, 2012

© 2013 Lippincott Williams & Wilkins, Inc.