Effects of HIV antiretrovirals on the pharmacokinetics of hormonal contraceptives
Effects of HIV antiretrovirals on the pharmacokinetics of hormonal contraceptives
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DOI：
10.1080/13625180701829952
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发表时间：
2008-06-01
影响因子：
1.7
通讯作者：
Cocohoba, Jennifer M.
中科院分区：
文献类型：
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作者：
El-Ibiary, Shareen Y.;Cocohoba, Jennifer M.
目的探讨HIV抗逆转录病毒药物对激素性避孕药的药代动力学效应。方法检索1964年至2006年间抗逆转录病毒药物的药代动力学信息，检索词分别为避孕药、避孕药、雌二醇、雌二醇、孕激素。对1998-2006年国际艾滋病学会年会和反转录病毒与机会性感染会议的摘要以及包装产品的插入进行了全面的回顾。结果含有蛋白酶抑制剂和非核苷类逆转录酶抑制剂的抗逆转录病毒方案可降低激素避孕药释放的类固醇的曲线下面积(AUC)水平。结论抗逆转录病毒药物与激素避孕药之间的药代动力学相互作用因使用的抗逆转录病毒药物和激素避孕药的不同而异。可以建议艾滋病毒阳性妇女使用荷尔蒙和屏障避孕的双重方法，以最大限度地有效防止怀孕，并减少艾滋病毒传播的可能性。口服避孕药可以服用非利托那韦或非利托那韦增强型阿扎那韦或非利托那韦增强型吲哚那韦，而不会失去避孕效果。醋酸甲羟孕酮与依沙韦仑、奈韦拉平和奈非那韦一起使用可能是安全的。然而，还需要进一步的研究来确定激素避孕药和抗逆转录病毒药物之间的相互作用的临床相关性，并探索潜在的剂量调整以提高避孕效果。
Objectives To review available information on pharmacokinetic effects of HIV antiretrovirals on hormonal contraceptives.Methods A PubMed search was conducted from 1964 to 2006 using each antiretroviral generic name and the keywords contraceptive, contraception, ethinyl oestradiol, oestrogen, and progestin. Abstracts from the annual Conference on Retroviruses and Opportunistic Infections and International AIDS Society Conferences from 1998-2006 as well as package product inserts were reviewed for completeness.Results Antiretroviral regimens containing protease inhibitors and non-nucleoside reverse transcriptase inhibitors may decrease the area under the curve (AUC) levels of steroids released by hormonal contraceptives. Some antiretroviral-hormonal contraceptive pairs do not decrease steroid hormone levels.Conclusion Pharmacokinetic interactions of antiretrovirals on hormonal contraceptives are specific to the type of antiretroviral and hormonal contraceptive being utilized. HIV-positive women may be counselled to use dual methods of hormonal and barrier contraception to prevent pregnancy with maximal efficacy as well as to reduce possibility of HIV transmission. Oral contraceptives might be administered with non-ritonavir boosted atazanavir or non-ritonavir boosted indinavir without a loss of contraceptive efficacy. Depot medroxyprogesterone acetate may be safe to administer with efavirenz, nevirapine, and nelfinavir. However, further studies are needed to determine the clinical relevance of the interactions between hormonal contraceptives and antiretrovirals and to explore potential dose adjustments to improve contraceptive efficacy.