HIV/AIDS Treatment and Care : Clinical protocols for the European ...

support for sexual and reproductive health in people living with hiv
4. Contraception for women on ARV
WHO recommends using highly active antiretroviral treatment (HAART) for PLHIV who are eligible
for ART in accordance with the WHO clinical staging system (for more information please see
Protocol 1, Patient evaluation and antiretroviral treatment for adults and adolescents).
ARV regimens recommended by the WHO Regional Office for Europe for first- and second-line
therapy are shown in Table 11.
Table 11.
recommended first- and second-line haart
regimens for adults and adolescents
First-line regimens Second-line regimens
ZDV + 3TC a + EFV b or NVP LPV/r c + ddI + ABC
LPV/r c + TDF + ABC
LPV/r c + TDF + (ZDV + 3TC) d
TDF + FTC a + EFV or NVP LPV/r c + ddI + ABC
LPV/r c + ddI + ZDV
ABC + 3TC a + EFV or NVP LPV/r c + ddI + ZDV
LPV/r c + (ZDV + 3TC) d
a 3TC (lamivudine) and FTC are considered interchangeable agents, given their activity, tolerance and resistance profiles. They
are both listed in this table as a reflection of the commonly available FDCs.
b For the purpose of this table, treatment failure on an NVP- or EFV (efavirenz)-based regimen is considered to result in NNRTI
class cross-resistance.
c LPV/r is listed as the preferred RTV-boosted protease inhibitor (PI) in this table, but other boosted PIs can be substituted based
on individual programme priorities. ATV/r, SQV/r, FPV/r and IDV/r are all possibilities. In the absence of a cold chain, NFV
can be employed as the PI component, but it is considered less potent than a boosted PI.
d ZDV + 3TC is listed here for “strategic” use, as resistance to both drugs is predicted to be present following failure on the
respective first-line regimen listed. ZDV may prevent or delay the emergence of the K65R mutation; 3TC will maintain the
M184V mutation, which may decrease viral replicative capacity as well as induce some degree of viral resensitization to ZDV.
It must be stressed that the clinical efficacy of this strategy in this situation has not been proven.
4.1. Interactions between ARVs and steroids in hormonal contraceptives
The limited data available suggest that several ARVs, especially NNRTIs and PIs, have the potential
to either decrease or increase the bioavailability of steroid hormones in hormonal contraceptives.
These drug interactions may alter the safety and effectiveness of both the hormonal contraceptives
and the ARVs. The possible interactions betweem ARVs and COCs, as well as the suggested alternatives,
should be taken into consideration and discussed with the patients.
335