Safety of hormonal and intrauterine methods of contraception for women with HIV/AIDS: a systematic review
- 1 November 2009
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in AIDS
- Vol. 23 (Suppl 1), S55-S67
- https://doi.org/10.1097/01.aids.0000363778.58203.b6
Abstract
To determine from the literature whether HIV-infected women who use hormonal or intrauterine contraception are at increased risk of HIV disease progression, other adverse health outcomes, or HIV transmission to uninfected sexual partners. A systematic review. We searched PubMed for articles published in peer-reviewed journals through August 2009 for evidence relevant to all hormonal and intrauterine contraceptive methods and HIV/AIDS. Eight observational studies reported no increased risk of HIV disease progression with hormonal or intrauterine contraceptive use, whereas one randomized controlled trial found increased risks of declining CD4 cell count and death for hormonal contraceptive users compared with intrauterine device users. Women with HIV who used hormonal contraception had increased risks of acquiring sexually transmitted infections compared with women not using hormonal contraception, similar to the risks reported among uninfected women. One study found no association between hormonal or intrauterine contraceptive use and increased risk of HIV transmission to uninfected partners, whereas findings from nine studies examining contraceptive use and viral shedding from the genital tract were inconsistent. Evidence regarding the safety of hormonal and intrauterine contraceptive use among women with HIV remains limited, but generally reassuring regarding adverse health effects, disease transmission to uninfected partners, and disease progression; however, one randomized trial raised concerns about enhanced disease progression among women using hormonal contraception. Preventing unintended pregnancy among women with HIV remains a high priority in public health, both for the health of the woman as well as for the prevention of mother-to-child transmission of HIV.Keywords
This publication has 36 references indexed in Scilit:
- Hormonal contraception and HIV disease progression: a multicountry cohort analysis of the MTCT-Plus InitiativeAIDS, 2009
- Pharmacokinetic interactions between depot medroxyprogesterone acetate and combination antiretroviral therapyFertility and Sterility, 2008
- Safety and tolerability of depot medroxyprogesterone acetate among HIV-infected women on antiretroviral therapy: ACTG A5093Contraception, 2008
- Family planning: the unfinished agendaThe Lancet, 2006
- The Value of Contraception to Prevent Perinatal HIV TransmissionSexually Transmitted Diseases, 2006
- Keeping up with Evidence: A New System for WHO’s Evidence-Based Family Planning GuidanceAmerican Journal of Preventive Medicine, 2005
- Cost-effectiveness of nevirapine to prevent mother-to-child HIV transmission in eight African countriesAIDS, 2004
- The effect of hormonal contraception on genital tract shedding of HIV-1AIDS, 2004
- Effect of hormonal contraceptive use on plasma HIV-1-RNA levels among HIV-infected womenAIDS, 2003
- Current methods of the U.S. Preventive Services Task ForceAmerican Journal of Preventive Medicine, 2001