GRADE table 4(Question 4): Are there any possible interactions between hormonal contraceptive methods and ARV medications?

OutcomeType and number of studies
(number of participants)		LimitationsInconsistencyImprecisionIndirectnessOther factorsQualityEstimate of effect
Hormonal contraception + antiretroviral therapy (ART) vs hormonal contraception alone
Pregnancy1 non-randomized trial (n=336); 1 cohort study (n=4531)Serious limitations
(1 good-quality non-randomized trial, 1 poor-quality cohort study)		No serious inconsistencyNo serious imprecisionNo indirectnessVariability in hormonal contraceptionVery low1 non-randomized trial found no difference in pregnancy rate with nevirapine-based ART + COC vs no ART; 1 cohort study found lower pregnancy rate prior to initiation of ART vs after initiation in women on various hormonal contraceptives, but estimates were imprecise (IRR 3.11 [95% CI 1.55–6.21] vs 5.38 [95% CI 2.89–10.00] for COC and 1.10 [95% CI 0.63–1.94] vs 1.97 [95% CI 1.28–3.01] for injectables)
Efavirenz (EFV) vs other ART in women using hormonal contraception
Pregnancy2 cohort studies (n=1197)Serious limitations
(2 fair)		UnclearSerious imprecisionNo indirectnessDenominators not provided in 1 studyVery low1 study found 12.4% pregnancy rate with EFV vs 0% with nevirapine (NVP) or loopinavir (LPV)/ritonavir (RTV) in women using LNG implant; 1 study reported 1 failure with EFV vs 7 with NVP in women using various hormonal contraceptives, but denominators were unclear
ART + hormonal contraception vs ART alone
ART effectiveness3 cohort studies (n=679)Serious limitations
(2 fair, 1 poor)		No serious inconsistencySerious imprecisionNo indirectnessVariability in hormonal contraception, ART regimens, and measures of ART effectivenessLowNo effect of hormonal contraception on measures of ART treatment failure in 3 studies (1 study of DMPA, 1 study of COCs, and 1 study of both)

CI: confidence interval; COC: combined oral contraceptive; DMPA: depot medroxyprogesterone acetate; IRR: incidence rate ratio.

Note: Table includes evidence from comparative studies reporting clinical outcomes.

From: I, Development of the Medical eligibility criteria for contraceptive use, fifth edition

Cover of Medical Eligibility Criteria for Contraceptive Use
Medical Eligibility Criteria for Contraceptive Use. 5th edition.
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