Etonogestrel Implants Research Articles

An exploratory analysis on the influence of genetic variants on weight gain among etonogestrel contraceptive implant users

ObjectiveTo identify genetic variants associated with weight gain related to etonogestrel contraceptive implant use. Study designWe conducted a retrospective analysis from a parent pharmacogenomic study of healthy, reproductive-aged women using etonogestrel implants. We reviewed medical records to calculate objective weight changes from implant insertion to study enrollment and asked participants about subjective weight gain (yes/no) during contraceptive implant use. We used genotyping data (99 genetic variants) from the parent study to conduct backward-stepwise generalized linear modeling to identify genetic variants associated with objective weight changes. ResultsAmong 276 ethnically diverse participants, median body-mass index (BMI) was 25.8 kg/m2 (range 18.5–48.1). We found a median weight change of +3.2 kg (range −27.6 to +26.5) from implant insertion to study enrollment. Report of subjective weight gain had minimal agreement with measured weight gain during implant use (Cohen’s kappa = 0.21). Our final generalized linear model contained two variables associated with objective weight change that met conservative statistical significance (p < 5.0 × 10−4). Participants with two copies (homozygous) of the ESR1 rs9340799 variant on average gained 14.1 kg more than all other participants (p = 1.4 × 10−4). Higher enrollment BMI was also associated with objective weight gain (β = 0.54, p = 9.4 × 10−12). ConclusionGenetic variants in the estrogen receptor 1 (ESR1) do not have known associations with obesity or metabolic syndrome, but there is physiologic plausibility for a progestin-mediated genetic association between ESR1 and weight gain. Additional genetic research is needed to substantiate our findings and elucidate further advances in individualized counseling on the risk of weight gain with exogenous steroid hormones. ImplicationsGenetic variation in the estrogen receptor 1 gene may account for variability in weight gain among etonogestrel contraceptive implant users. If these findings can be replicated with other progestin-containing medications, we may be able to better individualize contraceptive counseling.

107. No Missed Opportunities: A Trainee-Driven Long Acting Reversible Contraceptive Workshop for Pediatric Primary Care Clinicians

The American Academy of Pediatrics (AAP) recommends long-acting reversible contraceptives (LARCs), including intrauterine devices (IUDs) and etonogestrel implants, as first-line contraceptive methods for adolescents, yet fewer than 5% of adolescents ages 15-19 use these methods. Though pediatric providers are well positioned to provide LARCs, barriers include provider knowledge, attitude and experience, leading to missed opportunities to prevent teen pregnancy. An initial needs assessment identified that the majority of community pediatric providers were not providing LARCs. A survey of pediatric trainees revealed that 88% desired LARC training. To meet these needs, we implemented a LARC workshop open to all pediatric providers in the state including pediatric trainees, nurse practitioners and community providers. This study assesses the intervention’s impact and describes provider intentions to recommend and deliver LARC methods after the workshop.

Pregnancies associated with etonogestrel implants in the UK: comparison of two 5-year reporting periods

Objectives(1) To identify pregnancies associated with the use of the contraceptive implants Implanon and Nexplanon in the UK during two 5-year reporting periods. (2) To classify the possible reasons for...

Relationship Between Etonogestrel Concentrations and Bleeding Patterns in Contraceptive Implant Users.

To estimate whether serum etonogestrel concentrations influence bleeding patterns and related side effects in contraceptive implant users. We conducted a prospective cross-sectional study with healthy, reproductive-aged women using etonogestrel implants for 12-36 months. Participants completed a brief questionnaire to assess their current bleeding pattern and any experience of abnormal bleeding with the implant. We then measured serum etonogestrel concentrations. We also reviewed the charts of participants to determine whether a prescription for oral contraceptive pills was ever given for treatment of implant-related bothersome bleeding. We performed multivariable logistic regression to test for associations between serum etonogestrel concentrations and both bleeding patterns and related side effects. We enrolled 350 women, and 59.4% reported having experienced abnormal bleeding with the contraceptive implant. Only 14.9% of participants reported amenorrhea and 37.7% reported monthly periods. Among participants with reviewable medical records (n=253), roughly 20% had received a prescription for oral contraceptive pills during implant use. Increasing serum etonogestrel concentrations were significantly associated with increasing odds of reporting abnormal bleeding (adjusted odds ratio [aOR] 1.005, P=.015) and increasing odds of having received an oral contraceptive pill prescription (aOR 1.008, P=.002). For every 100 pg/mL increase in serum etonogestrel concentration, contraceptive implant users in this study had 1.6 times the odds of reporting abnormal bleeding and 2.3 times the odds of having received a prescription as treatment for bothersome bleeding. We found both objective and subjective evidence that higher levels of progestin from the contraceptive implant were associated with bleeding side effects experienced by women in this study. Pharmacologic variation may influence the side effects women experience with a variety of hormonal contraceptive methods, in turn affecting patient satisfaction and discontinuation rates.

Hormonal Contraceptives, Female Sexual Dysfunction, and Managing Strategies: A Review.

In recent decades, hormonal contraceptives (HC) has made a difference in the control of female fertility, taking an unequivocal role in improving contraceptive efficacy. Some side effects of hormonal treatments have been carefully studied. However, the influence of these drugs on female sexual functioning is not so clear, although variations in the plasma levels of sexual hormones could be associated with sexual dysfunction. Permanent hormonal modifications, during menopause or caused by some endocrine pathologies, could be directly related to sexual dysfunction in some cases but not in all of them. HC use seems to be responsible for a decrease of circulating androgen, estradiol, and progesterone levels, as well as for the inhibition of oxytocin functioning. Hormonal contraceptive use could alter women’s pair-bonding behavior, reduce neural response to the expectation of erotic stimuli, and increase sexual jealousy. There are contradictory results from different studies regarding the association between sexual dysfunction and hormonal contraceptives, so it could be firmly said that additional research is needed. When contraceptive-related female sexual dysfunction is suspected, the recommended therapy is the discontinuation of contraceptives with consideration of an alternative method, such as levonorgestrel-releasing intrauterine systems, copper intrauterine contraceptives, etonogestrel implants, the permanent sterilization of either partner (when future fertility is not desired), or a contraceptive ring.

Influence of Genetic Variants on Steady-State Etonogestrel Concentrations Among Contraceptive Implant Users.

To identify genetic variants that influence steady-state etonogestrel concentrations among contraceptive implant users. We enrolled healthy, reproductive-age women in our pharmacogenomic study using etonogestrel implants for 12-36 months without concomitant use of hepatic enzyme inducers or inhibitors. We collected participant characteristics, measured serum etonogestrel concentrations, and genotyped each participant for 120 single nucleotide variants in 14 genes encoding proteins involved in steroid hormone (ie, estrogens, progestins) metabolism, regulation, or function. We performed generalized linear modeling to identify genetic variants associated with steady-state etonogestrel concentrations. We enrolled 350 women, who had a median serum etonogestrel concentration of 137.4 pg/mL (range 55.8-695.1). Our final generalized linear model contained three genetic variants associated with serum etonogestrel concentrations: NR1I2(PXR) rs2461817 (β=13.36, P=.005), PGR rs537681 (β=-29.77, P=.007), and CYP3A7*1C (β=-35.06, P=.025). Variant allele frequencies were 69.4%, 84.9%, and 5.1%, respectively. Our linear model also contained two nongenetic factors associated with etonogestrel concentrations: body mass index (BMI) (β=-3.08, P=7.0×10) and duration of implant use (β=-1.60, P=5.8×10); R for the model =0.17. Only BMI and duration of implant use remained significantly associated with steady-state etonogestrel concentrations. Of the three novel genetic associations found, one variant associated with increased etonogestrel metabolism (CYP3A7*1C) causes adult expression of fetal CYP3A7 proteins and can consequently alter steroid hormone metabolism. Women with this variant may potentially have increased metabolism of all steroid hormones, as 27.8% (5/18) of CYP3A7*1C carriers had serum etonogestrel concentrations that fell below the threshold for consistent ovulatory suppression (less than 90 pg/mL). More pharmacogenomic investigations are needed to advance our understanding of how genetic variation can influence the effectiveness and safety of hormonal contraception, and lay the groundwork for personalized medicine approaches in women's health. ClinicalTrials.gov, NCT03092037.

17. Factors Associated with Early Removal of the Etonogestrel Implant for Bothersome Bleeding in Adolescents

17. Factors Associated with Early Removal of the Etonogestrel Implant for Bothersome Bleeding in Adolescents

Postpartum hormonal contraception use and incidence of postpartum depression: a systematic review

Purpose: To evaluate the association between postpartum hormonal contraceptive use and postpartum depression.Materials and methods: We searched the literature through March 2018 on the association between postpartum hormonal contraception use and incident postpartum depression. We used the United States Preventive Services Task Force framework to assess study quality.Results: Of 167 articles identified, four met inclusion criteria. Two studies found no differences in rates of postpartum depression between women using postpartum depot medroxyprogesterone and those not using hormonal contraception; however, a study of women receiving injectable norethisterone enanthate immediately postpartum found a 2–3-fold increased risk of depression at 6 weeks, though not at 3 months. One study compared combined hormonal contraception, progestin-only pills (POPs), etonogestrel implants and levonorgestrel intrauterine devices (LNG-IUDs) with no hormonal contraception, and found a 35–44% decreased risk of postpartum depression with POPs and LNG-IUDs, a small increased risk of postpartum antidepressant use among women using the etonogestrel implant and vaginal ring, and a decreased risk of antidepressant use with POPs.Conclusions: Limited evidence found no consistent associations between hormonal contraceptive use and incidence of postpartum depression. Future research would be strengthened by using validated diagnostic measures, careful consideration of confounders, and ensuring adequate follow-up time.

Birth Control Pills and Thrombotic Risks: Differences of Contraception Methods with and without Estrogen.

In Germany one-third of the women in fertile age use combined oral contraceptives (COCs), which consist mostly of ethinylestradiol (EE) and a synthetic progestin. Older COCs with norethisterone or levonorgestrel have a lower risk for venous thromboembolism (VTE) than newer COCs with desogestrel, drospirenone, or gestodene. This is also true for nonoral combined hormonal contraceptives. The risk of newer COCs containing estradiol instead of EE is not clear due to missing data. Progestin-only hormonal contraception is not associated with a significant increase of the risk for VTE with the exception of depot medroxyprogesterone acetate. Emergency contraceptions, which do not contain EE, but only levonorgestrel or ulipristal acetate, do not result in a higher risk for VTE. Oral desogestrel- or levonorgestrel-only contraceptives, intrauterine device, and etonogestrel implants are the contraception of choice in women with a history of VTE and/or suffering from thrombophilia. These safe contraceptives should be offered to women with high risk of VTE due to the much higher VTE risk in pregnancy and postpartum. The screening for thrombophilia is not indicated in every woman with the wish for contraception. This should be restricted to certain cases, for example to women with a positive history for VTE or with close relatives suffering from VTE in younger than 50 years.

Treatment of Adenomyosis with Subcutaneous Etonogestrel Implants: A Clinical Observational Study in 17 Patients.

BackgroundAdenomyosis is a cause of chronic pelvic pain in women of reproductive age. The aim of this study was to investigate the effects of subcutaneous etonogestrel implantation on adenomyosis.Material/MethodsA clinical observational study included 17 women with adenomyosis who were treated with subcutaneous etonogestrel implants and followed-up for 12 months. Imaging and clinical observations were undertaken in the 17 patients at baseline (time 0), and at 3 months, 6 months, and 12 months following subcutaneous etonogestrel implantation. The following imaging and clinical findings were compared between baseline (time 0) and 12-month follow-up: menstrual bleeding pattern, dysmenorrhea, visual analog scale (VAS) pain score, uterine volume, serum cancer antigen 125 (CA125) levels, hemoglobin, follicle-stimulating hormone (FSH) levels, luteinizing hormone levels, serum estradiol levels, and any treatment side effects.ResultsAll 17 patients treated with etonogestrel implants completed the 12-month follow-up, at which time, the mean hemoglobin level (127.08±2.56 g/L) was significantly higher compared with that at baseline (94.54±5.47 g/L; P<0.01); uterine volume, serum CA125, and VAS score for dysmenorrhea at 12 months (118.03±12.83 cm3, 34.58±9.66 U/mL, and 1.45±0.35, respectively) were significantly lower when compared with baseline (198.53±39.47 cm3, 100.41±49.89 U/mL, and 7.62±0.74, respectively) (P<0.01, for all). However, changes in bleeding pattern and amenorrhoea occurred after treatment in some women.ConclusionsSubcutaneous etonogestrel was effective in reducing some symptoms and signs of adenomyosis, including dysmenorrhea, anemia, serum CA125, and uterine volume.

Effects of etonogestrel implant on quality of life, sexual function, and pelvic pain in women suffering from endometriosis: results from a multicenter, prospective, observational study.

Progestins are successfully employed as treatment for endometriosis. Our study evaluates the effects of the etonogestrel (ENG) implant on pelvic pain, quality of life, and sexual function in women requiring long-term reversible contraception and presenting ovarian cysts of probable endometriotic origin. We enrolled 25 women asking for contraception with the ENG implant and presenting a cyst with the ultrasound features of an endometrioma and pain symptoms. Patients were interviewed on pain symptoms (dysmenorrhea, dyspareunia, dyschezia, and dysuria) using a VAS score (0-10), on quality of life (QoL) using the Short Form-36 questionnaire, and on sexual activity using the Female Sexual Function Index (FSFI) questionnaire before inserting the implant (T0) and after 6 (T1) and 12months (T2). We found a significant decrease in dysmenorrhea and dyspareunia VAS scores comparing baseline scores to 6 and 12months. After 12months, the bodily pain, general health, vitality, social functioning, and mental health domains of the QoL score were significantly improved. The total FSFI score results increased in comparison with baseline both at 6 and 12months. In particular, we highlighted a significant improvement in desire, satisfaction, and pain domains already at 6months; the arousal domain improved only after 12months. Finally, mean diameters of endometrioma-like cysts were not changed after 12months of treatment. Etonogestrel implants seem to be able to reduce pelvic pain, improve sexual function, and quality of life in patients with ovarian cysts suspected of endometriotic origin.

A multicenter randomized clinical trial of etonogestrel and levonorgestrel contraceptive implants with nonrandomized copper intrauterine device controls: effect on weight variations up to 3 years after placement

ObjectivesTo evaluate weight changes in women randomized to either the etonogestrel (ENG)- or the levonorgestrel (LNG)-releasing contraceptive implants and to compare with users of the TCu380A intrauterine device (IUD). Study designA multicenter randomized trial with 1:1 allocation ratio of the ENG and the LNG implants with nonrandomized, age-matched control group of women choosing TCu380A IUD. The primary objective was to assess contraceptive efficacy and method continuation rates and, secondarily, the incidence of common complaints and side effects (including weight changes) associated with use of the three contraceptives. All women were enrolled in nine centers at seven countries. Weight change was evaluated from time at device(s) placement. Confounders were sociodemographic, baseline weight and body mass index, center and time from insertion. We used a linear mixed-effects regression modeling with random intercept and slope. Weight was compared between the two implants groups and between the implants and the IUD groups through linear mixed multivariable regression model. ResultsA total of 995, 997 and 971 users in the ENG implant, LNG implant and IUD groups, respectively, were included. At 36 months of use, ENG and LNG implant users had similar significant mean weight increase of 3.0 kg [95% confidence interval (CI) 2.5–3.5] and 2.9 kg (95% CI 2.4–3.4), respectively (p<.0001), while IUD users had an increase of 1.1 kg (95% CI 0.5–1.7) (p=.0003). On adding the group–time interaction term to the stratified baseline weight models, implant users gained 0.759 kg (standard error [SE] .11) and 0.787 kg (SE .22) more weight than their IUD-user counterparts per year since placement if their baseline weight was in the category 51–69 kg (p<.0001) or ≥70 kg (p=.0005), respectively. ConclusionsENG and LNG implant as well as IUD users had a small but significant weight increase with little clinical significance during the 3 years of follow-up, and it was slightly higher among implant than IUD users weighing >50 kg. ImplicationsThese findings must be useful for clinicians to counsel implant users which could improve method continuation.

Timing of Etonogestrel Implant Insertion After Dilation and Evacuation

To compare the 6-month use rate of the etonogestrel implant placed immediately after dilation and evacuation (D&E) with placement 2-4 weeks postprocedure. This is a randomized controlled trial of women seeking abortion between 14 0/7 and 23 5/7 weeks of gestation and desiring the etonogestrel contraceptive implant at an urban family planning clinic. Participants were randomized to device insertion immediately after the D&E compared with delayed insertion in 2-4 weeks. The primary outcome was implant use rate at 6 months after insertion and was determined by follow-up phone interviews. Secondary outcomes included repeat pregnancy rates and method satisfaction. The sample size of 120 participants was calculated based on a power of 0.80 to demonstrate a 20% difference in implant use rates between groups assuming 40% of women overall are not using the device 6 months after the procedure. Between November 2015 and October 2016, 148 participants were enrolled. Seventy-three participants (49.3%) were randomized to and underwent immediate implant insertion after D&E. The remaining 75 (50.6%) were randomized to delayed insertion. There were no significant differences in sociodemographic characteristics between the groups. Placement rate was 100% in the immediate group compared with 42.7% in the delayed group (P<.01). At 6 months, 40 of 43 (93%) women from the immediate group who completed follow-up continued use of the implant, whereas 19 of 30 (63.3%) women from the delayed group who completed follow-up were using the device (P=.002). Follow-up rates were low at 58.9% in the immediate group compared with 40.0% in the delayed group. Women were more likely to be using the etonogestrel implant at 6 months after D&E if they underwent immediate compared with delayed insertion. The very high loss to follow-up rate makes it difficult to draw conclusions about acceptability of the device and pregnancy rates. ClinicalTrials.gov, 02037919.

Continuation of long-acting reversible contraceptives among Medicaid patients

ObjectiveOur objective was to compare continuation and complication rates of subdermal etonogestrel implants and intrauterine devices (IUDs) using Medicaid insurance claims. Study designWe performed a retrospective cohort study using insurance claims data for 15- to 44-year-old subjects receiving implants or IUDs from 2012 to 2015 in a Medicaid managed care organization in Washington, DC, and Maryland. We performed a planned Kaplan–Meier survival analysis for long-acting reversible contraceptive (LARC) continuation, defined as the absence of a claim for LARC removal, during periods of continuous insurance plan enrollment. ResultsThree thousand one hundred three subjects received 1335 implants and 1970 IUDs, with implants more common than IUDs among subjects 15–19 years old (rate ratio=2.42), and implants less common than IUDs for subjects 20–44 years old (rate ratio=0.54). Implants had higher continuation rates at 1 year than IUDs (81.0% vs. 76.7%, p=.01). The difference was larger among subjects 25 to 44 years old (84.1% vs. 79.3%, p=.03) compared with subjects 15 to 19 years old (89.5% vs. 86.8%, p=.09) and subjects 20 to 24 years old (75.7% vs. 73.2%, p=.44). Claims for potential complications were similarly uncommon for both implants and IUDs (8.09% vs. 6.95%, p=.65), as were claims for pregnancies prior to LARC removal (0.82% vs. 0.86%, p=.86). ConclusionAmong a sample of 15- to 44-year-old Medicaid recipients, both implants and IUDs had high continuation rates and low complication rates; however, implants were slightly more likely than IUDs to remain in use 1 year after insertion. ImplicationsAmong 15- to 44-year-old Medicaid recipients, both etonogestrel implants and IUDs have high continuation rates and low complication rates at 1-year postinsertion; however, implants are slightly more likely than IUDs to remain in use at 1 year.

Contraceptive Implant Placement is Seldom Complicated

A growing number of women use subdermal etonogestrel implants for contraception. To describe clinical outcomes of the occasions when these implants

Temporal Trends in the Uptake and Continuation of the Etonogestrel Implant in a Large Private Practice Setting

To assess temporal trends in the uptake and continuation of the etonogestrel subdermal implant in a large private practice setting. This was a retrospective cohort study based on billing records from a large multispecialty private practice in Las Vegas, Nevada. We looked at women of all ages seeking long-acting reversible contraception (LARC) between January 1, 2013, and December 31, 2016. The main outcome measure was uptake of the etonogestrel subdermal implant, expressed as a fraction of all insertions of LARC across four calendar years (2013-2016). The Kaplan-Meier method was used to estimate 12-month continuation stratified by year of insertion. There were 3477 total LARC insertions across the 4-year study period. In unadjusted analyses, the uptake of the etonogestrel implant increased from 3.0% of LARC insertions in 2013 to 9% in 2016 among women aged 30 years and older. For women younger than 30 years, the uptake of the implant stayed stable from 2013 to 2015 (22.8%, 21.7%, and 22.4%, respectively), but increased to 30.9% in 2016. We modeled the uptake of the implant as a function of year of insertion adjusted for age (continuous) and insurance status (private vs. Medicaid), and we stratified the models by age (younger than 30 years, 30 years, and older than 30 years). The positive association between year of insertion and uptake of the implant was significantly stronger for women aged 30 years and older, compared to women younger than 30 years. There was a progressive decrease in the 12-month continuation of implant from 2013 (95.7%) to 2015 (57.7%). In this large private practice setting, among women aged 30 years and older, we observed a threefold increase in the uptake of the subdermal implant from 2013 to 2016. We also observed a significant decrease in the 12-month continuation of the implant over time. Further studies of implant uptake and continuation in the private practice setting are needed.

Utility of an open-access database for comparing adverse events associated with etonogestrel implants in pediatric and adult populations

Utility of an open-access database for comparing adverse events associated with etonogestrel implants in pediatric and adult populations

Etonogestrel implant migration to the vasculature, chest wall, and distant body sites: cases from a pharmacovigilance database

ObjectiveTo describe clinical outcomes of etonogestrel implant patients with migration to the vasculature, chest wall and other distant body sites spontaneously reported to the US Food and Drug Administration Adverse Event Reporting System (FAERS) database. Study designWe performed a standardized Medical Dictionary for Regulatory Activities (MedDRA) query in the FAERS database (through November 15, 2015), with reports coded with one or more MedDRA preferred terms that indicate complications with device placement or migration of the device from the original site of insertion to the vasculature, chest wall and other distant body sites. We excluded any cases previously described in the medical literature. ResultsWe identified 38 cases of pronounced etonogestrel implant migration. Migration locations included the lung/pulmonary artery (n=9), chest wall (n=1), vasculature at locations other than the lung/pulmonary artery (n=14) and extravascular migrations (n=14) to other body sites (e.g., the axilla and clavicle/neck line/shoulder). The majority of cases were asymptomatic and detected when the patient desired implant removal; however, seven cases reported symptoms such as pain, discomfort and dyspnea in association with implant migration. Three cases also describe pulmonary fibrosis and skin reactions as a result of implant migration to the vasculature, chest wall and other distant body sites. Sixteen cases reported surgical removal in an operating room setting. ConclusionsOur FAERS case series demonstrates etonogestrel implant migration to the vasculature, chest wall and other body sites distant from the site of original insertion. Implications statementAs noted by the sponsor in current prescribing information, a key determinant in the risk for etonogestrel contraceptive implant migration appears to be improper insertion technique. Although migration of etonogestrel implants to the vasculature is rare, awareness of migration and education on proper insertion technique may reduce the risk.

ETONOGESTREL IMPLANT (IMPLANON);

Objective: To assess the frequency of adverse effects caused by implantationof single-rod Etonogestrel implant (Implanon) in females seeking birth spacing after deliveryof previous pregnancy. Study Design: Descriptive case series. Setting: Unit V, Departmentof Obstetrics &amp; Gynecology, and Lady Aitcheson Hospital Lahore. Period: One year from01/04/2015 to 31/03/2016. Materials &amp; methods: A total of 130 women fulfilling our selectioncriteria were selected. The ENG implant is a single (coaxial) rod made up of an ethylene vinylacetate (EVA) copolymer core (40% EVA) containing 68mg ENG, surrounded by a 60mm skinof EVA copolymer (100% EVA). The implant was inserted during days 1 to 5 of spontaneousmenses and left in place and adverse effects (abnormal vaginal bleeding or pregnancy)was measured (as per operational definition) for a period of 3 months. All this informationwas recorded in proforma (attached). Data was entered and analyzed in SPSS version 17.0.Results: The mean age of females was 29.08 ± 4.027 years with minimum and maximumage of 20 and 40 years. Adverse events were seen in 36(27.7%) of the females while other94(72.3%) did not have any adverse effect of implantation of single-rod Etonogestrel implant(Implanon) in females seeking birth spacing after delivery of previous pregnancy. Abnormalvaginal bleeding was reported by 19(14.6%) and pregnancy was occurred in 17(13.1%) of thefemales. Conclusion: According to the findings of this study we found less adverse effects likeabnormal vaginal bleeding in 19(14.6%) females and pregnancy was occurred in 17(13.1%)of the females. Hence we conclude Implanon is an effective mode of contraception in femalesseeking birth spacing and can be adopted in females seeking family planning.

Effect of Coadministration of Etonogestrel Implant and Antiretroviral Therapies Containing Efavirenz or Lopinavir/Ritonavir on the Metabolism of Women Living with HIV/AIDS

Background: Concomitant use of antiretroviral therapy (ART) and hormonal contraceptives should be safe for women while maintaining medication efficacy without causing significant immunological or metabolic changes. However, the metabolic effect of the concomitant use of etonogestrel (ENG)-releasing implant and commonly used ARTs is not known. Objective: To evaluate the effect of coadministration of ENG-releasing implant and ARTs containing lopinavir/ ritonavir or efavirenz on the metabolic parameters of women living with human immunodeficiency virus (HIV) infection/ acquired immune deficiency syndrome (AIDS). Methods: This is an open, prospective, non-randomized exploratory study. Forty-five women who sought to receive the ENG contraceptive implant were selected, including 15 non-ART users, 15 zidovudine/lamivudine (AZT/3TC)+lopinavir/ritonavir users and 15 AZT/3TC+efavirenz users for at least 3 months. Clinical and metabolic parameters were assessed before, during and 24 weeks after implant insertion. Results: At 24 weeks after ENG implant insertion, the group without ART showed a 4.7% increase in albumin level (p=0.03), a 6.2% decrease in total cholesterol level (p=0.03) and a 5.6% increase in alkaline phosphatase level (p<0.01), whereas the lopinavir/ritonavir group showed a 12.5% increase in aspartate aminotransferase (p=0.03). The efavirenz group showed a 12.9% decrease in low-density lipoprotein (p=0.03). The other results showed no significant changes during the 24 week study. The observed changes remained within the normal values for the parameters. Conclusion: Co-administration of ENG implant with ARTs containing lopinavir/ritonavir or efavirenz is not associated with clinically relevant metabolic changes in women living with HIV infection/AIDS, after a 6 month followup period.