Table 3. Drug Interactions Between Antiretroviral Agents and Hormonal Contraceptives

• No effect on EE concentrations
• ↓ active metabolites of norgestimate; LNG AUC ↓ 83% and norelgestromin AUC ↓ 64%²⁹
• Etonogestrel (in COC) C_24h ↓ 61%³⁵

• No effect on DMPA levels^26,28 

• ↓ 49% in Etonorgestrel concentration ⁴⁵
• Etonogestrel AUC ↓ 63% to 82%^49,53
• ↑ pregnancy incidence rate among women using LNG or ENG implants, more among ENG users.⁵¹

• ↓ 61% LNG concentration ⁴⁵
• LNG AUC ↓ 47%⁴⁰
• LNG (emergency contraception) AUC ↓ 58%²⁴ 
• ↑ pregnancy incidence rate among women using LNG or ENG implants, more among ENG users.⁵¹

• No effect on EFV concentrations²⁹
• EFV C_12h ↓ 22%; was under therapeutic threshold in three of 16 subjects³⁵

• No effect on HIV disease progression^26,54,55
• No effect on EFV concentrations²⁶

• No effect on HIV disease progression⁴⁰

• Etonogestrel ↓ 79%
• EE ↓ 59%⁵⁶

• No difference in pregnancy rates⁵⁰
• Pregnancy rate was 13% higher in women using COCs and EFV than in women using COCs alone^48,57
• Progesterone >3 ng/mL (a surrogate for ovulation) in three of 16 women⁵⁸
• No ovulations²⁹

• No increase in pregnancy rates^26,48,50,55
• Low progesterone^26,28,55

• Pregnancy rate higher with EFV compared with no ART, but still lower with implants than with other hormonal methods of contraception⁴⁸
• Presumptive ovulation in 5%⁵³

• 12% pregnancy rate³⁶
• 15% pregnancy rate⁴⁰
• Pregnancy rate higher with EFV compared with no ART, but still lower with implants than with other hormonal methods of contraception⁴⁸
• No increase in pregnancy rate⁵⁰

• No ovulations⁵⁹

EE AUC ↓ 29%;⁶⁰ no change in EE AUC⁶¹

NE AUC ↓ 18%⁶⁰

Etonogestrel (in COC) C_24h ↓ 22%³⁵

DMPA:

• No significant change²⁶

• LNG AUC ↑ 35%⁴⁰
• ↑ pregnancy incidence rate among women using LNG or ENG implants, more among ENG users.⁵¹

• No significant effect on NVP levels^58,60,62

• No effect on HIV disease progression^26,54,55,63

• No effect on HIV disease progression^40,64

• No increase in pregnancy rate^{48,50,57,65,66}
• No ovulations^58,61,66

• No increase in pregnancy rate^48,50,55,65
• No ovulations²⁶

• No increase in pregnancy rate⁴⁸

• No increase in pregnancy rate^{36,40,48,50,64}

No significant change on NE³⁴

No change in RPV levels compared to historical controls^{34​​​​​​​}

• No change in progesterone³⁴

• NE AUC ↑ 50%^{69​​​​​​​}

• Etonogestrel ↑ 71%
• EE ↓ 38%⁵⁶

• EE AUC ↓ 45%²⁵
• Norelgestromin AUC ↑ 83%²⁵

• DMPA AUC ↑ 46%³⁸

• Etonogestrel AUC ↑ 52%^{53​​​​​​​}

• LPV/r ↓ 19%²⁵

• No effect on HIV disease progression^{38​​​​​​​}
• No change in LPV/r levels³⁸

• Increased pregnancy rate, but CIs overlap⁴⁸

• No ovulations²⁵

• No pregnancies and no ovulations³⁸
• Increased pregnancy rate, but CIs overlap⁴⁸

• No increase in pregnancy rate⁴⁸

• No increase in pregnancy rate^36,48

Drospirenone AUC ↑ 2.3-fold

No change in LNG concentration

25% decrease in EE C₂₄⁴²

• EE AUC ↑ 48%⁷¹
• NE AUC ↑ 110%⁷¹

• No significant effect on EE or LN⁷²

• No significant effect on norgestimate or EE
• No change in DTG AUC³⁹

• Norgestimate AUC ↑ 126%
• EE AUC ↓ 25%^{73,74​​​​​​​}

• No change in EE
• Norgestimate AUC ↑ 14% ⁷⁵