Contraception in women HIV infected

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⁾.
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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.