Contraception Guidelines Updated for Women at HIV Risk

Laurie Barclay, MD

June 23, 2012

June 23, 2012 — The US Centers for Disease Control and Prevention (CDC) has updated its 2010 recommendations regarding the use of hormonal contraception among women at high risk for HIV infection. The new guideline, which is based on a CDC review of recent evidence regarding hormonal contraceptive use and the risk for HIV acquisition, transmission, and disease progression, is published in the June 22 issue of Morbidity and Mortality Weekly Report.

"Prevention of unintended pregnancy among women at risk for [HIV] infection or infected with HIV is critically important," write Naomi K. Tepper, MD, and colleagues from the CDC National Center for Chronic Disease Prevention and Health Promotion. "One strategy for preventing unintended pregnancies in this population is improving access to a broad range of effective contraceptive methods."

About 4 million women at risk for unintended pregnancy in the United States are not using contraception, and in 2010, an estimated 10,000 new HIV infections occurred among US women. Risks of pregnancy include morbidity, mortality, and a possible increased risk for HIV infection. Among HIV-infected women, pregnancy is associated with additional risks, including the risk for mother-to-child transmission of HIV.

Recommendations in the updated guidelines that affirm the 2010 recommendations include the following:

  • For women who are at high risk for HIV infection or who are infected with HIV, the use of hormonal contraceptives is safe. These methods include combined hormonal contraceptives, progestin-only pills, depot medroxyprogesterone acetate, and implants.

  • Clinicians should counsel all women who use contraceptive methods other than condoms regarding the use of condoms and the risk for sexually transmitted infections.

The updated guidelines also contain a new clarification added to the recommendation for women at high risk for HIV infection who use progestin-only injectables. This clarification acknowledges that the body of evidence concerning the association between progestin-only injectable use and HIV acquisition is inconclusive. Therefore, women at high risk for HIV infection who use progestin-only injectables should use condoms and other strategies to prevent HIV. Expansion of the contraceptive method mix is essential, as is the need for further research on these issues.

The updated guidelines also point out possible drug interactions between hormonal contraceptives and antiretroviral drugs. Because antiretroviral drugs are often indicated in patients with HIV infection without AIDS, the revised guidelines note that this warning applies to all patients with HIV infection.

"Contraception is critically important to prevent unintended pregnancy among women at risk for HIV infection or infected with HIV and such women can continue to use all hormonal contraceptive methods without restriction," the review authors write. "However, HIV infection preventive measures, such as voluntary testing and counseling, access and adherence to [antiretroviral] drugs, and correct and consistent use of condoms, should be strongly encouraged among all women at risk for HIV acquisition and women living with HIV infection."

Morb Mortal Wkly Rep. 2012;61:449-452. Full text

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