HIV-positive women have reproductive patterns similar to those of HIV-negative women and would benefit from counselling about reversible methods of contraception. AIDS/WHO estimates that 42 million people are living with HIV/AIDS worldwide and 50% of all adults with HIV infection are women, predominantly infected via heterosexual transmission (1).
Particularly, HIV/AIDS disproportionately affects young women of color (2). Recent, Highly Active Antiretroviral Therapy (HAART), with or without protease inhibitor (PI), has greatly improved the outlook for HIV-infected women, even those with an AIDS diagnosis (3).
Consequently, the dramatic reduction in HIV-related morbility and mortality had led to a growing number of HIV-infected individuals and their partners requiring education and counseling regarding HIV-disease and reproduction (4).
Assessment of options for birth control, and pre-conception counseling should be integral components of gynecologic health care for these women (5). The use of hormonal contraception by HIV-1-infected women seems to be associated with an increased risk of cervicitis and cervical chlamydia infection.
HIV-1-seropositive women using hormonal contraception should be counseled about the importance of consistent condom use to prevent both sexually transmitted diseases (STI) and HIV-1 transmission (6). HIV infected womens need to be prepared to integrate contraception and gynecological care.
In fact, underuse of highly effective contraception and barrier methods leaves women with HIV-infection at risk for unintended pregnancy and disease transmission (3). Was reported that among HIV-seropositive women,barrier use is more likely among women who had been pregnant(OR 1.37) and among those with higher CD4 lymphocyte counts (OR 1.10, p = 0.0006), whereas hormone use was linked to higher CD4 counts (OR 1.12, p=.01)(6).
Adverse Effects of Hormonal contraception
- Cardiovascular Effects
- - Myocardial Infarction
- - Stroke
- - Arterial Accidents
- - Venous Thromboembolism
- - Blood Hypertension
- Other Effects
- - Angioedema
- - Peliosis Hepatis
- - Severe Adverse Ocular Reactions
- - Vasculitis
- Moderate adverse effects
- Cancer Risks
- - Breast cancer risk
- - Ovarian cancer risk
- - Endometrial cancer risk
- - Cervical cancer risk
- - Colorectal cancer risk
- - Skin cancer risk
- - Liver cancer risk
- - Pancreatic cancer risk
- - Neurofibromas growth
- - Unclear cancer risks
- Hazardous prescription
- Hormonal contraception in female transplant recipients
- - Hormonal contraception in female kidney recipients
- - Hormonal contraception in female liver transplant recipients
- - Hormonal contraception in female heart transplant recipients
- - Contraception in women HIV infected
- Mild Adverse effects
- New Perspectives immunocontraception
- Contraceptive counseling
It is evident that in areas at high prevalence for HIV-infection, selection of longer-acting injectable contraception could be associated with lower rates of pregnancy among HIV-positive women. (7)
It seems that women using the injectable contraceptive depot medroxyprogesterone acetate might be at increased risk of Chlamydia trachomatis infection (hazard ratio (HR) 3.1, P = 0.05) and cervicitis (HR 1.6, P = 0.03) compared with women using no contraception. While, the use of oral contraceptive pills could be associated with an increased risk of cervicitis (HR 2.3, P = 0.001).
Hormonal contraception seems not associated with an increased risk of infection with Neisseria gonorrhoeae (3). HIV-1-seropositive women using hormonal contraception should be counseled about the importance of consistent condom use to prevent both STI and HIV-1 transmission.
In multivariate analysis, use of hormonal, either estrogen/progesterone oral combination or medroxyprogesterone acetate intramuscular contraceptives, high cervical mucous concentrations of interleukin (IL)-12, a positive HPV test, and persistent low-grade squamous intraepithelial lesion (LSIL) were significantly associated with the development of HSIL. The role of hormonal contraception as a risk factor deserves further investigation. (Infectious Diseases Society of America) (8).
However, in the past was believed a trend between use of high–dose oral contraceptive pills and HIV-acquisition (HR 2.6), today no association was found between hormonal contraceptive use and HIV acquisition, overall. Furthermore, users who are HIV-seronegative but Herpes-simplex-virus type 2 (HSV- 2) seropositive seem to have an higherrisk (9,10,11). How to promote dual protection (combined hormonal contraceptive plus condom) and how to make them acceptable in long-term relationship remains a challenge. Therefore, support for the birth control in women living with HIV is a priority (12).
General Hospital Policlinico, University of Bari, Italy
- Mitchell, H.S., Stephens, E. (2004).Contraception choice for HIV positive women. Sex. Transm. Infect, 80(3), 167-73.
- Rove, C., Perlmutter Silverman, P., Krauss, B.(2007). A brief, low-cost, theory-based intervention to promote dual method use by black and Latina female adolescents:a randomized clinical trial. Health Educ.Behav, 34(4), 608-21.
- Massad, L.S., Evans, C.T., Wilson, T.E., Golub, E.T., Sanchez-Keeland, L., Minkoff, H., Weber, K., Watts, D.H. (2007). Contraceptive use among U.S. women with HIV. J.Women Health(Larchmt), Jun,16(5), 657-66.
- Barreiro, P., Duerr, A., Beckerman, K., Soriano, V. (2006). Reproductive options for HIV-serodiscordant couple. AIDS Rev,8(3),158-70.
- Aaron, E., Levine, A.B. (2005). Gynecologic care and family planning for HIV-infected women. AIDS Read, 15(8), 420-3,426-8.
- Lavreys, L., Chohan, V., Overbaugh, J., Hassan, W., McClelland, R.S., Kreiss, J., Mandaliya, K., Ndinya-Achola, J., Baeten, J.M. (2004). Hormonal contraception and risk of cervical infections among HIV-1-seropositive Kenyan women. AIDS, Nov 5, 18(16), 2179-84.
- Mark, K.E., Meinzen–Derr, J., Stephenson, R., Haworth, A., Ahmed, Y., Duncan, D., Westfall, A., Allen, S. (2007). Contraception among HIV concordant and discordant couples in Zambia:a randomized controlled trial. J. Womens Health(Larchmt), 16(8),1200-10.
- Moscicki AB, Ellenberg JH, Crowley-Nowick P, Darragh TM, Zu J, Fahrat S. (2004). Risk of high-grade squamous intraepithelial lesion in HIV-infected adolescents. J.Infect.Dis, 190(8), 1413-21.
- Martin, H.L. Jr., Nyange, P.M., Richardson, B.A., Lavreys, L., Mandaliya, K., Jackson, D.J., Ndinya-Achola, J.O., Kreiss, J. (1998). Hormonal contraception,sexually transmitted diseases,and risk of heterosexual transmission of human immunideficiency virus type 1. J.Infect.Dis, 178(4), 1053-9.
- Morrison, C.S., Richardson, B.A., Mmiro, F., Chipato, T., Celentano, D.D., Luoto, J., Mugerwa, R., Padian, N., Rugpao, S., Brown, J.M., Cornelisse, P., Salata, R.A. (2007). Hormonal Contraception and the Risk of HIV Acquisition(HC-HIV)Study Group. Hormonal contraception and the risk of HIV acquisition. AIDS, 21(1), 85-95.
- Macqueen, K.M., Johnson, L., Alleman, P., Akumatey, B., Lawoyin, T., Nyiama, T. (2007). Pregnancy prevention practices among women with multiple partners in an HIV prevention trial. J.Acquir.Immune Defic. Syndr, 46(1), 32-8.
- Delvaux, T., Noslinger, C. (2007). Reproductive choice for women and men living with HIV: contraception, abortion and fertility. Reprod. Health Matters, 15(29 Suppl.), 46-66.