Levonorgestrel in contraceptives and multipurpose prevention technologies: does this progestin increase HIV risk or interact with antiretrovirals?

Mounting observational evidence suggests that use of certain types of hormonal contraception, specifically the progestin-only injectable depot medroxyprogesterone acetate (DMPA), may be associated with an increased risk of HIV acquisition in women [1]. This relationship has been examined in several observational studies and is currently being assessed in a randomized trial, the evidence for contraceptive options and HIV outcomes (ECHO) study (NCT02550067). As evidence continues to evolve, it is also necessary to critically examine knowledge gaps for other contraceptive progestins. Levonorgestrel is used in many existing contraceptives and is being evaluated for use in multipurpose prevention technologies (MPTs). MPTs are designed to simultaneously prevent two or more of the following: unintended pregnancy, HIV, and other sexually transmitted infections. Potential drug–drug interactions and side-effect profiles must also be considered in developing products, including some MPTs, which would contain levonorgestrel and antiretrovirals. Vaginal rings containing dapivirine or tenofovir (NCT02235662) for HIV