Contraception in women HIV infected

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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 Conclusion

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⁾.

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Rosa Sabatini
General Hospital Policlinico, University of Bari, Italy
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REFERENCES

1. Mitchell, H.S., Stephens, E.  (2004).Contraception choice for HIV positive women. Sex. Transm. Infect, 80(3), 167-73. 
2. 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. 
3. 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.
4. Barreiro, P., Duerr, A., Beckerman, K., Soriano, V.  (2006).  Reproductive options for HIV-serodiscordant couple. AIDS Rev,8(3),158-70. 
5. Aaron, E., Levine, A.B.  (2005). Gynecologic care and family planning for HIV-infected women. AIDS Read, 15(8), 420-3,426-8. 
6. 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.
7. 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. 
8. 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.
9. 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.
10. 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.
11. 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.
12. 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. 

RELATED STORIES:
Contraceptive counseling   Progesterone Receptor Modulators (PMRS) and Progesterone Antagonists (PAS)   Conclusion - adverse effects of Hormonal contraception   New Perspectives immunocontraception   Low Libido as adverse effect of Hormonal contraception   Vaginal Infections as adverse effect of Hormonal contraception   Depression as adverse effect of Hormonal contraception   Ovarian cysts as adverse effect of Hormonal contraception   Irregular Bleeding Pattern as adverse effect of Hormonal contraception   Mild Adverse effects of Hormonal contraception   Dermatological Adverse effects   Headache as Adverse Effect of Hormonal contraception   Adverse effects on carbohydrate and lipid metabolism   Moderate adverse effects hepatobiliary complications   Hormonal contraception in female heart transplant recipients

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