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Depot Contraception With and Without Lopinavir/Ritonavir

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT01231451
Recruitment Status : Withdrawn (Ethics board said the study could not be fully justified.)
First Posted : November 1, 2010
Last Update Posted : November 29, 2010
Information provided by:
St Stephens Aids Trust

Brief Summary:

DMPA (depot medroxyprogesterone acetate or the 'depot' injection) is a widely used contraception. It is popular in woman with HIV as it probably still works when you take HIV drugs. HIV drugs can increase or decrease the level of other drugs (e.g. contraceptives) in your bloodstream which may make them work less well or increase side effects. It is assumed that DMPA can be given with HIV drugs there are no studies proving this.

The purpose of the study is to investigate whether an HIV drug combination containing lopinavir/ritonavir affects DMPA when they are taken at the same time.

Condition or disease Intervention/treatment Phase
HIV Infection Drug: DMPA Phase 1

Detailed Description:

Lopinavir/ritonavir (LPV/r) is licensed for use in combination with other antiretrovirals for the treatment of HIV infection. Like other agents from the protease inhibitor class, LPV/r inhibits the 3A isoenzyme of the hepatic cytochrome P450 system and may increase the levels of drugs metabolised via this route. However, LPV/r has also been shown in vivo to induce its own metabolism and to increase the biotransformation of some drugs metabolized by P450 enzymes and by glucuronidation.

Women account for an increasing proportion of the HIV epidemic in the UK. The huge reductions in HIV-related mortality and morbidity associated with the use of effective combination antiretroviral therapy have led to a shift in focus to longer term issues, including reproductive health and contraception. The impact of a variety of antiretrovirals on the plasma pharmacokinetics of oral oestrogen and progesterone preparations have been investigated and in general NNRTIs and boosted PIs cause a reduction in levels of both, particularly oral oestrogen preparations. Most package inserts for combined (oestrogen and progestogen) and progestogen-only oral contraceptives recommend that additional contraceptive methods be employed with concomitant use of enzyme-inducing agents.

Injectable contraception provides highly effective contraception without the need for daily pill taking, an important factor to consider for individuals already taking regular medication. Depot medroxyprogesterone acetate (DMPA) is the most frequently prescribed injectable method. DMPA, like other progestogens, is metabolised by the cytochrome P450 system but interaction studies in women on antiretrovirals are limited. A study of 59 women on DMPA contraception plus an unboosted PI (nelfinavir) or an NNRTI (efavirenz or nevirapine) measured DMPA levels and compared them with 16 women on either no therapy or NRTIs only (no potential for drug interaction). DMPA levels were similar in all groups and suppression of ovulation over a 12 week period was also similar in all groups.

Although the high levels of DMPA achieved over the dosing interval make any pharmacokinetic interaction unlikely to be clinically significant, some clinicians advise a reduction in the interval between DMPA injections from 12 to 10 weeks in patients on an NNRTI or boosted PI; there is no clear evidence to support this approach. Although the described study supports normal dosing intervals for women on an NNRTI, the unboosted PI nelfinavir is not recommended as standard of care and the impact of ritonavir-boosted PIs is unclear. The summary of product characteristics for DMPA advises a normal dosing interval even when using a potent enzyme inducers, suggesting no additional intervention is required when prescribing a boosted PI. Formal pharmacokinetic data is crucial to clarify this important area.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 10 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Prevention
Official Title: The Pharmacokinetics of Depot Medroxyprogesterone Acetate (DMPA) in the Absence and Presence of Lopinavir/Ritonavir in HIV-1 Infected Women
Study Start Date : December 2010
Estimated Primary Completion Date : June 2011
Estimated Study Completion Date : June 2011

Resource links provided by the National Library of Medicine

Arm Intervention/treatment
Experimental: All Subjects
All Subjects will receive the same intervention
Drug: DMPA
All subjects will take DMPA

Primary Outcome Measures :
  1. pharmacokinetics of depot medroxyprogesterone acetate (DMPA) [ Time Frame: week 1 - week 24 ]

    To investigate the pharmacokinetics of depot medroxyprogesterone acetate (DMPA) in the absence and presence of lopinavir/ritonavir in HIV-

    1 infected women

Secondary Outcome Measures :
  1. Impact of co-administration of DMPA and lopinavir/ritonavir [ Time Frame: Week 1 - week 24 ]
    To investigate the impact of co-administration of DMPA and lopinavir/ritonavir on surrogate markers of contraceptive efficacy (LH, FSH, oestradiol)

  2. Safety of DMPA [ Time Frame: Week 1 - week 24 ]
    To investigate the safety of DMPA in HIV infected women on lopinavir/ritonavir

  3. Impact of DMPA on lopinavir/ritonavir plasma concentrations [ Time Frame: week 1 - week 24 ]
    To investigate the impact of DMPA on lopinavir/ritonavir plasma concentrations compared with historical controls

Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 45 Years   (Adult)
Sexes Eligible for Study:   Female
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  1. The ability to understand and sign a written informed consent form, prior to participation in any screening procedure and must be willing to comply with all study requirements.
  2. Non-pregnant, non-lactating premenopausal females.
  3. No current hormonal contraception (short acting methods eg oral contraceptive pills and patches can be removed at screening)
  4. Regular menstrual periods such that DMPA can be administered between days 1-5 of menstrual cycle
  5. Between 18 and 45 years, inclusive.
  6. Documented HIV-1 infection
  7. Must be willing to use a barrier method of contraception to avoid pregnancy throughout the study, and for at least 56 days following completion of the study.
  8. CD4 count > 200 at screening (Note: retesting of screening CD4 count allowed).
  9. Clinician and patient happy to delay HAART until week 12 of study
  10. Not currently on HAART and eligible to receive LPV/r and Truvada as determined by their primary HIV care provider in accordance with treatment guidelines
  11. If history of HAART exposure, no virological failure (prior drug switches allowed if for tolerability/toxicity/convenience of dosing).
  12. Agrees not to change regimen, outside the study recommendations, from baseline until end of the treatment period unless this is medically indicated as decided by the treating physician

Exclusion Criteria:

  1. Any serious or active medical or psychiatric illness which, in the opinion of the investigator, would interfere with subject treatment, assessment, or compliance with the protocol. This would include any active clinically significant renal, cardiac, hepatic, pulmonary, vascular, metabolic disorders or malignancy.
  2. Have a body mass index (BMI) >35
  3. Personal history of venous thromboembolism (VTE) or pulmonary embolism (PE)
  4. Presence of any current active AIDS defining illness (Category C conditions in the CDC Classification System for HIV 1993) except stable cutaneous Kaposi's Sarcoma
  5. Osteoporosis or significant risk factors for osteoporosis (alcohol abuse, long-term anticonvulsants/corticosteroids, BMI less than 18, eating disorder, previous low trauma fracture, significant family history osteoporosis)
  6. Conditions for which DMPA is contra-indicated or risks outweigh benefits:

    1. Significant multiple risk factors for arterial cardiovascular disease
    2. Vascular disease
    3. Previous or current venous thromboembolism (VTE) or pulmonary embolism (PE)
    4. Ischaemic heart disease
    5. Stroke (history of cerebrovascular accident)
    6. Headaches migraine with aura, at any age
    7. Unexplained vaginal bleeding
    8. Gestational trophoblastic neoplasia (GTN) (includes hydatidiform mole, invasive mole, placental site trophoblastic tumour) hCG abnormal
    9. Breast cancer (past or current) or strong family history
    10. Diabetes nephropathy/retinopathy/neuropathy
    11. Other vascular disease or diabetes of >20 years' duration
    12. Viral hepatitis (active)
    13. Presence or history of any sever hepatic disease where liver function tests have not returned to normal
    14. Cirrhosis (decompensated)
  7. Clinically relevant alcohol or drug use (positive urine drug screen, excluding cannabinoids) or history of alcohol or drug use considered by the Investigator to be sufficient to hinder compliance, follow-up procedures or evaluation of adverse events. Smoking is permitted, but tobacco intake should remain consistent throughout the study.
  8. The use of disallowed concomitant therapy (See section 5.2).
  9. Previous allergy to any of the constituents of the study pharmaceuticals.
  10. Exposure to any investigational drug or placebo within 4 weeks of baseline.
  11. Any HAART exposure within 6 months of screening for this study (ie participants need to be treatment-naïve or on a treatment interruption for 6 months or more).

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT01231451

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United Kingdom
St Stephen's Centre
London, United Kingdom, SW10 9NH
Sponsors and Collaborators
St Stephens Aids Trust
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Responsible Party: Dr Laura Waters, St Stephen's AIDS Trust Identifier: NCT01231451    
Other Study ID Numbers: SSAT 038
First Posted: November 1, 2010    Key Record Dates
Last Update Posted: November 29, 2010
Last Verified: November 2010
Keywords provided by St Stephens Aids Trust:
HIV Infection
Additional relevant MeSH terms:
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HIV Infections
Lentivirus Infections
Retroviridae Infections
RNA Virus Infections
Virus Diseases
Sexually Transmitted Diseases, Viral
Sexually Transmitted Diseases
Immunologic Deficiency Syndromes
Immune System Diseases