title: Bleeding patterns of HIV-infected women using an etonogestrel-releasing contraceptive implant and efavirenz-based or lopinavir/ritonavir-based antiretroviral therapy.
abstract: OBJECTIVE
  The use of progestogen-only contraceptives may cause a change in bleeding pattern, which is a common cause of discontinuation of these methods. Co-administration with some antiretroviral therapies (ART) changes the bioavailability of the etonogestrel (ENG)-releasing contraceptive implant, possibly affecting the bleeding pattern. Bleeding patterns were evaluated in HIV-positive users of the ENG implant co-administered with two common ART regimens.
  
  
  METHODS
  Forty-five HIV-positive women who wished to use an ENG implant were included in this study: 15 had received zidovudine/lamivudine (AZT/3TC) + lopinavir/ritonavir (LPV/r) for ≥3 months (LPV/r-based ART group), 15 had received AZT/3TC + efavirenz (EFV) for ≥3 months (EFV-based ART group), and 15 had not received ART (non-ART group). Bleeding patterns were evaluated at 3 and 6 months after implant placement using a standard bleeding calendar.
  
  
  RESULTS
  Amenorrhoea and infrequent bleeding rates were higher in the LPV/r-based ART group (50% and 36%, respectively) than in the other groups (non-ART group, 36% and 29%, respectively; EFV-based ART group, 7% and 14.5%, respectively; p = 0.01). The EFV-based ART group more frequently had regular bleeding (71.5%) compared with the other groups (LPV/r-based ART group, 7%; non-ART group, 21%; p = 0.01). The proportions of women with frequent and prolonged bleeding were similar (p > 0.05) in the three groups.
  
  
  CONCLUSIONS
  The co-administration of EFV-based or LPV/r-based ART with the ENG implant affected the expected bleeding patterns during use of the implant, although unfavourable bleeding (frequent and prolonged) was not associated with the medications under evaluation.
authors.affiliation: a Department of Gynecology and Obstetrics , Medical School of Ribeirão Preto, University of São Paulo , Ribeirão Preto , São Paulo , Brazil ;
authors.forename: Conrado S
authors.initials: CS
authors.lastname: Ragazini
authors.affiliation: b Department of Obstetrics and Gynecology , School of Medical Sciences, University of Campinas , Campinas , São Paulo , Brazil ;
authors.forename: Maria Valeria
authors.initials: MV
authors.lastname: Bahamondes
authors.affiliation: a Department of Gynecology and Obstetrics , Medical School of Ribeirão Preto, University of São Paulo , Ribeirão Preto , São Paulo , Brazil ;
authors.forename: Tatiana R Rocha
authors.initials: TR
authors.lastname: Prandini
authors.affiliation: c Bahiana School of Medicine and Public Health , Salvador , Brazil.
authors.forename: Milena Bastos
authors.initials: MB
authors.lastname: Brito
authors.affiliation: b Department of Obstetrics and Gynecology , School of Medical Sciences, University of Campinas , Campinas , São Paulo , Brazil ;
authors.forename: Eliana
authors.initials: E
authors.lastname: Amaral
authors.affiliation: b Department of Obstetrics and Gynecology , School of Medical Sciences, University of Campinas , Campinas , São Paulo , Brazil ;
authors.forename: Luis
authors.initials: L
authors.lastname: Bahamondes
authors.affiliation: a Department of Gynecology and Obstetrics , Medical School of Ribeirão Preto, University of São Paulo , Ribeirão Preto , São Paulo , Brazil ;
authors.forename: Geraldo
authors.initials: G
authors.lastname: Duarte
authors.affiliation: a Department of Gynecology and Obstetrics , Medical School of Ribeirão Preto, University of São Paulo , Ribeirão Preto , São Paulo , Brazil ;
authors.forename: Silvana Maria
authors.initials: SM
authors.lastname: Quintana
authors.affiliation: a Department of Gynecology and Obstetrics , Medical School of Ribeirão Preto, University of São Paulo , Ribeirão Preto , São Paulo , Brazil ;
authors.forename: Rui Alberto
authors.initials: RA
authors.lastname: Ferriani
authors.affiliation: a Department of Gynecology and Obstetrics , Medical School of Ribeirão Preto, University of São Paulo , Ribeirão Preto , São Paulo , Brazil ;
authors.forename: Carolina Sales
authors.initials: CS
authors.lastname: Vieira
mesh_terms: D000293:Adolescent; D000328:Adult; D000480:Alkynes; D000568:Amenorrhea / Q000139:chemically induced*; D019380:Anti-HIV Agents / Q000494:pharmacology* / Q000627:therapeutic use; D048588:Benzoxazines / Q000494:pharmacology / Q000627:therapeutic use; D003521:Cyclopropanes; D017135:Desogestrel / Q000009:adverse effects* / Q000494:pharmacology*; D004338:Drug Combinations; D004343:Drug Implants / Q000009:adverse effects / Q000494:pharmacology; D004347:Drug Interactions; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D019259:Lamivudine / Q000494:pharmacology / Q000627:therapeutic use; D061466:Lopinavir / Q000494:pharmacology / Q000627:therapeutic use; D008796:Metrorrhagia / Q000139:chemically induced; D011446:Prospective Studies; D019438:Ritonavir / Q000494:pharmacology / Q000627:therapeutic use; D055815:Young Adult; D015215:Zidovudine / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D004338:Drug Combinations; D004343:Drug Implants; C109078:lamivudine, zidovudine drug combination; C558899:lopinavir-ritonavir drug combination; D061466:Lopinavir; D019259:Lamivudine; C044815:etonogestrel; D015215:Zidovudine; D017135:Desogestrel; C098320:efavirenz; D019438:Ritonavir
keywords: Bleeding pattern; HIV; contraceptive; etonogestrel