Investigating Contraceptive Effectiveness When Co-Administered With Efavirenz: A Systematic Review

HIV has been a global public health challenge throughout the past decades. In order to ensure proper protection from mother-to-child-transmission and the safety of women on antiretrovirals, their contraceptive agents need to be effective when co-administered with antiretroviral drugs, specifically Efavirenz. Studies have disputed the effects of this co-administration, and thus further research is needed, hence the methodology of a systematic review.

Objective: The aim of this systematic review is to compile and analyse relevant sources that investigate the effects that contraceptive agents have on antiretroviral therapy. The main objective is to establish some answers in regards to the existence of a relationship, focusing solely on female human subjects currently on the antiretroviral medication, Efavirenz.

Methodology: A systematic review that compiles sources located on the scientific databases, Web of Science, Embase, and PubMed. Sources found through snowballing were additionally included. The quality of these studies has been assessed utilising an adaptation of a published quality assessment criterion. The systematic review included only human subjects, and studies from the last 10 years (2008 – 2018) to retain modernity. Results: Five out of six studies investigating the co-administration of EFV-based ARV and implant contraceptive agents showed a positive relationship. Two out of four studies showed a positive relationship between the co-administration of EFV-based ARV and oral contraceptive agents. All three studies investigating the co-administration of EFV-based ARV and injectable contraceptive agents show that there is no relationship between the two.

Conclusion: A higher risk of contraceptive failure and unintended pregnancies is found when co-administering EFV-based ARV and implant contraceptive devices. More research is needed to collect evidence on this relationship.