Hazardous prescription

However,  also women with familial defect of biliary excretion, including the Dubin-Johnson syndrome, Rotor’s syndrome, and benign intrahepatic recurrent cholestasis should not take oral contraceptives (41).

Comprehensive contraceptive counselling for HIV-1 infected women requires an understanding of the effects of various contraceptive methods on HIV-1 disease progression (42).

A recent study carried out on 4549 women aged 15-24 in four African countries reports that users of DMPA have a significantly,  higher seroprevalence than non users; while, oral contraceptives and traditional methods did not show any risk for HIV (43).On the contrary, other investigators affirmed that DMPA did not affect CD4+ counts or HIV RNA levels (44).

Besides, another study performed in Zambia on 599 post-partum women, HIV-infected shows that clinical disease progression (death or CD4+ lymphocyte count dropping below 200 cells/  microL)  was more common in hormonal contraceptive users (13.2/100 woman-years) than in IUD users (45). This observation requires caution and urgent further studies. In addition, it is important to remember that antiretroviral regimens containing protease inhibitors and non-nucleoside reverse transcriptase inhibitors may decrease the levels of steroids released by hormonal contraceptives (46).

Rosa Sabatini
General Hospital Policlinico, University of Bari, Italy


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