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JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0000000000000189
Clinical Science

Effect of Antiretroviral Therapy Including Lopinavir/Ritonavir or Efavirenz on Etonogestrel-Releasing Implant Pharmacokinetics in HIV-Positive Women

Vieira, Carolina S. MD, PhD*,†; Bahamondes, Maria V. MD, PhD†,‡; de Souza, Roberto M. PhD§; Brito, Milena B. MD, PhD; Rocha Prandini, Tatiana R. MD*; Amaral, Eliana MD, PhD; Bahamondes, Luis MD, PhD†,‡; Duarte, Geraldo MD, PhD*; Quintana, Silvana M. MD, PhD*; Scaranari, Carolina MD*; Ferriani, Rui A. MD, PhD*,†

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Objective: Data on the interaction between the etonogestrel (ENG) implant and antiretroviral therapy are lacking. We evaluated the effect of 2 highly active antiretroviral therapy (HAART) regimens (1 including efavirenz and the other ritonavir-boosted lopinavir) on the pharmacokinetic (PK) parameters of an ENG-releasing implant in HIV-positive women.

Design: Prospective nonrandomized PK study.

Methods: Forty-five HIV-positive women who desired to use ENG implants were included: 15 had received zidovudine/lamivudine + lopinavir/ritonavir for ≥3 months (LPV/r-based HAART group), 15 had received zidovudine/lamivudine + efavirenz for ≥3 months (EFV-based HAART group), and 15 had not received HAART (non-HAART group). PK parameters were measured using ultra-performance liquid chromatography–mass spectrometry at baseline and 2, 4, 6, 8, 10, 12, 16, 20, and 24 weeks after implant placement.

Results: The EFV-based HAART regimen was associated with a reduction in the bioavailability of ENG, which showed decreases of 63.4%, 53.7%, and 70% in the area under the curve (AUC), maximum concentration (Cmax), and minimum concentration (Cmin) of ENG, respectively, compared with the non-HAART group. The LPV/r-based HAART regimen was associated with an increase in ENG bioavailability, which showed 52%, 60.6%, and 33.8% increases in the ENG AUC, Cmax, and Cmin, respectively, compared with the non-HAART group.

Conclusions: The coadministration of EFV decreased the bioavailability of ENG released from the implant, which could impair contraceptive efficacy. However, the coadministration of LPV/r increased the bioavailability of ENG released from the implant, which suggests that this antiretroviral combination does not impair the ENG implant efficacy.

© 2014 by Lippincott Williams & Wilkins


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