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Etonogestrel concentrations among contraceptive implant users in Botswana using and not using dolutegravir-based antiretroviral therapy

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Bishop, Ian J, Gertz, Alida M, Simon, Boikhutso, Tawe, Leabaneng, Lechiile, Kwana, Liu, Serena, Teodoro, Nicholas, Mussa, Aamirah, Avalos, Ava, Malima, Sifelani, Maotwe, Tshego, Mokganya, Lesego, Westhoff, Carolyn L and Morroni, Chelsea ORCID: https://orcid.org/0000-0002-2026-6039 (2020) 'Etonogestrel concentrations among contraceptive implant users in Botswana using and not using dolutegravir-based antiretroviral therapy'. Contraception. (In Press)

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Abstract

Objectives:
To evaluate whether etonogestrel concentrations are reduced to a level that could potentially reduce contraceptive efficacy when the etonogestrel contraceptive implant is used concomitantly with dolutegravir-based antiretroviral therapy (ART).

Study Design:
We conducted a non-randomized, open-label, cross-sectional pharmacokinetic study among women using single-rod etonogestrel contraceptive implants in Botswana. We compared plasma etonogestrel concentrations, sampled at a single time-point between 3 and 12 months from implant insertion, among implant users living with HIV and receiving dolutegravir-based ART with HIV-negative implant users. We also assessed concentrations among implant users living with HIV and receiving efavirenz-based ART. We compared geometric mean etonogestrel concentrations analyzing data from 142 participants: 97 HIV-negative, 30 using dolutegravir, and 15 using efavirenz.

Results:
The groups were similar. Duration of implant use was between 3 and 12 months (median=5). Geometric mean etonogestrel plasma concentrations and 90% confidence intervals of the mean were 227.5(212.4-243.8), 289.6(251.8-333.0) and 76.4(63.9-91.4) pg/mL among the HIV-negative, dolutegravir- and efavirenz-based ART groups, respectively. All women in the HIV-negative and dolutegravir-based ART groups had etonogestrel concentrations above 90pg/mL; 9/15 women (60%) using efavirenz-based ART had concentrations below 90 pg/mL. On average, etonogestrel levels were lower among individuals who had implants inserted for longer durations.

Conclusions:
Implant users receiving dolutegravir-based ART had a higher mean etonogestrel concentration compared to HIV-negative women, and none had etonogestrel concentrations below the posited threshold for ovulation suppression. In contrast, women in the efavirenz-group had much lower etonogestrel concentrations. Overall, these data provide evidence that the etonogestrel implant may be effectively combined with dolutegravir-based ART regimens.

Item Type: Article
Subjects: QV Pharmacology > Reproductive Control Agents > QV 177 Contraceptives
QV Pharmacology > QV 38 Drug action.
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503 Acquired immunodeficiency syndrome. HIV infections
WC Communicable Diseases > Virus Diseases > Acquired Immunodeficiency Syndrome. HIV Infections > WC 503.6 Prevention and control
WP Gynecology > Contraception > WP 630 Contraception
WP Gynecology > Contraception > WP 640 Contraceptive devices (General and female)
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1016/j.contraception.2020.04.019
Depositing User: Rachel Dominguez
Date Deposited: 21 May 2020 11:51
Last Modified: 21 May 2020 11:51
URI: https://archive.lstmed.ac.uk/id/eprint/14468

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