AIDS (London, England) · 2025
Effectiveness of levonorgestrel implant and depot medroxyprogesterone acetate injectable for women with HIV on efavirenz.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Mollan Katie R, Pence Brian W, Westreich Daniel, Bula Agatha, Lemani Clara, Chapola John, Hagey Jill M, Diepstra Karen, Winston Jennifer, Phiri Sam, Chiwoko Jane, Chinula Lameck, Hosseinipour Mina C, Hudgens Michael G, Cottrell Mackenzie L, Pettifor Audrey, Jonsson-Funk Michele, Tang Jennifer H
Аннотация
OBJECTIVE: We compared the contraceptive effectiveness of typical-use LNG implant and depot medroxyprogesterone acetate (DMPA) injectable during efavirenz use.
DESIGN: We conducted a prospective cohort study of women with HIV (WHIV) on efavirenz-containing antiretroviral treatment in Lilongwe, Malawi. Eligible participants were 18-40 years of age and initiating LNG implant or DMPA injectable with a desire to prevent pregnancy for 4+ years. Study visits and urine pregnancy testing occurred at enrollment, week 4, and every 24 weeks up to week 192. Malawi's efavirenz-to-dolutegravir transition shortened our duration of efavirenz follow-up.
METHODS: Pregnancy incidence rates/100 person-years and an incidence rate difference (IRD) were estimated using an inverse-probability-weighted Poisson model.
RESULTS: We enrolled 1179 WHIV on efavirenz: 592 and 587 chose to initiate the LNG implant and DMPA, respectively. Median follow-up during efavirenz use was 1.1 years [interquartile range (IQR): 0.5-1.7]. Estimated pregnancy incidence rates were 6.6/100 person-years [95% confidence interval (95% CI): 5.0-8.7] in the LNG implant enrollment group (50 pregnancies) and 7.3/100 person-years (95% CI: 5.5-9.7) in the DMPA enrollment group (54 pregnancies), IRD -0.7/100 person-years (95% CI: -3.5 to 2.0). Results were similar in an analysis of first incident pregnancy during continued typical use of LNG implant (5.7/100 person-years) versus continued typical use of DMPA (5.7/100 person-years), IRD 0.0/100 person-years (95% CI: -2.6 to 2.7).
CONCLUSION: In many settings, LNG implant has better contraceptive effectiveness than DMPA injectable. However, for WHIV on efavirenz, we observed similar typical-use effectiveness for LNG implant versus provider-administrated DMPA injectable during the initial 1-2 years of use.
DESIGN: We conducted a prospective cohort study of women with HIV (WHIV) on efavirenz-containing antiretroviral treatment in Lilongwe, Malawi. Eligible participants were 18-40 years of age and initiating LNG implant or DMPA injectable with a desire to prevent pregnancy for 4+ years. Study visits and urine pregnancy testing occurred at enrollment, week 4, and every 24 weeks up to week 192. Malawi's efavirenz-to-dolutegravir transition shortened our duration of efavirenz follow-up.
METHODS: Pregnancy incidence rates/100 person-years and an incidence rate difference (IRD) were estimated using an inverse-probability-weighted Poisson model.
RESULTS: We enrolled 1179 WHIV on efavirenz: 592 and 587 chose to initiate the LNG implant and DMPA, respectively. Median follow-up during efavirenz use was 1.1 years [interquartile range (IQR): 0.5-1.7]. Estimated pregnancy incidence rates were 6.6/100 person-years [95% confidence interval (95% CI): 5.0-8.7] in the LNG implant enrollment group (50 pregnancies) and 7.3/100 person-years (95% CI: 5.5-9.7) in the DMPA enrollment group (54 pregnancies), IRD -0.7/100 person-years (95% CI: -3.5 to 2.0). Results were similar in an analysis of first incident pregnancy during continued typical use of LNG implant (5.7/100 person-years) versus continued typical use of DMPA (5.7/100 person-years), IRD 0.0/100 person-years (95% CI: -2.6 to 2.7).
CONCLUSION: In many settings, LNG implant has better contraceptive effectiveness than DMPA injectable. However, for WHIV on efavirenz, we observed similar typical-use effectiveness for LNG implant versus provider-administrated DMPA injectable during the initial 1-2 years of use.