Dr Milena Murray: Be Careful When Prescribing ART for Patients on Hormonal Contraception

Certain antiretroviral therapies can decrease contraception’s effectiveness, so it's important to have family-planning conversations, said Milena Murray, PharmD, MSc, BCIDP, AAHIVP, associate professor at Midwestern University College of Pharmacy, who practices at Northwestern Medicine's Infectious Disease Center in Chicago.

Transcript

How might hormonal contraceptives and antiretroviral therapies interact in ways that could counteract their effects in female patients living with HIV?

Family planning conversations are so important to have with every patient at each clinic visit, and there are drug interactions that decrease the effectiveness of the hormonal contraceptives. And we know that most medications or antiretroviral medications are not affected by the hormones themselves. So it’s really important to not prescribe antiretrovirals that are going to decrease the effectiveness of the hormones, because that may lead to unintended pregnancies. However, it has to be a conversation with the patient about what do they prefer. Do they want an injectable hormonal contraceptive? Do they want an intrauterine device?

Some of these obviously have less drug interactions than oral hormonal contraceptives. And there are many antiretrovirals that now do not interact. So it shouldn’t be a, “Oh, we can’t use these at all,” because there’s no options for the patients. It’s really about the preference of the patients, the effectiveness, having that conversation just as you would with a patient not living with HIV and making sure that if they don’t want children at this point, that we’re doing the best to help them with that. And if they do want children, that we’re prescribing antiretrovirals that are preferred in pregnancy, as well as looking at the rest of their comedications to make sure they’re not on anything that might be teratogenic.