DMPA Is Safe With Concurrent TB, HIV Treatment

The use of depot medroxyprogesterone acetate (DMPA) is safe and well-tolerated among women receiving efavirenz and rifampicin to treat HIV-associated tuberculosis (TB), according to new study results presented at the Conference on Retroviruses and Opportunistic Infections 2019.

Effective contraception is important for young women with HIV-associated TB. Rifampicin and efavirenz are known to reduce concentrations of contraceptive medications. Yet, the impact of the effects of rifampicin and efavirenz on DMPA has remained unknown.

In a new pharmacokinetics study, Dr Rosie Mngqibisa from the Enhancing Care Foundation in South Africa and colleagues evaluated MPA concentrations over time among women residing in sub-Saharan Africa who were receiving stable efavirenz-based ART and rifampicin-based TB treatment.

Plasma MPA concentrations were determined pre-dose and at 2, 4, 6, 8, 10, and 12 weeks after 150 mg injection of DMPA. Plasma progesterone levels were measured starting after week 2.

The number of women with sub-therapeutic MPA levels served as the study’s primary outcome.

Overall, 5 women (11.9%) had MPA 5 ng/mL—which suggested ovulation—throughout the study and at week 12. The median area under the concentration time curve over 12 weeks was lower (7.63 vs 12.38 ng*per week/mL) and clearance was higher (19,681 vs 12,117 L/per week) compared with historical controls.

More women in the control group experienced MPA clearance, leading to sub-therapeutic concentrations of MPA in some women at 10 and 12 weeks after dosing. Progesterone levels normally associated with ovulation were not evident.

No grade 3 or higher adverse events attributable to DMPA were reported.

“It may be prudent to dose DMPA more frequently than every 12 weeks in women on efavirenz with HIV-associated TB taking rifampicin,” the researchers concluded.

—Melinda Stevens

Reference:

Mngqibisa R, Cohn SE, Kendall MA, et al. Potential concern for timing of DMPA injection among women treated for HIV and TB. Paper presented at: Conference on Retroviruses and Opportunistic Infections; March 4-7, 2019; Seattle, WA. http://www.croiconference.org/sessions/potential-concern-timing-dmpa-injection-among-women-treated-hiv-and-tb.  Accessed March 7, 2019.