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

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, Vol 102, Issue 3, pp. 174-179.

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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:	07 May 2021 01:02
URI:	https://archive.lstmed.ac.uk/id/eprint/14468

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