Contraceptive Pearl: Contraception for HIV Infected Women
What’s the best contraceptive for HIV-infected women? To choose the right form of birth control, clinicians and patients must consider medication interactions, transmission to uninfected partners, and disease progression. Because pregnancy carries significant health risks for HIV-infected women, close attention to contraception is especially important in this group. Condoms remain the only method that prevents both transmission of HIV and unintended pregnancy. However, condoms have only modest efficacy for contraception, so most HIV-infected women should combine them with a second method.
Spermicide may raise the risk of HIV transmission by causing genital irritation. Spermicide-based methods are rarely the best choice for HIV-infected women.
What about hormonal methods? Although studies have yielded conflicting results, on balance, they show that hormonal contraceptives do not raise womens’ risk of HIV disease progression or transmission to partners. For HIV-infected women who aren’t taking antiretrovirals, contraceptive pills, patch, ring, injections, and implants may be used without restriction.
However, hormonal contraceptives do interact with some antiretroviral medications. According to the CDC’s Medical Eligibility for Initiating Contraception chart, both combined estrogen/progestin and progestin-only pills get a “3” for women taking protease inhibitors and a “2” for women taking Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI) antiretrovirals. Women taking Nucleoside Reverse Transcriptase Inhibitor (NRTI) antiretrovirals may use combined OCs, progestin-only pills, and progestin injections or implants without restriction.
What about IUDs? Although evidence is limited, studies show that IUDs do not raise the risk of HIV transmission or complications. HIV-infected women who are clinically well can choose either the copper or progestin IUD. (Both get a “2” from the CDC.) Women with AIDS who are ill may still choose either IUD; but clinicians should watch carefully for signs of pelvic infection following insertion.
Providing high-quality contraception to women with HIV can prolong their lives and prevent HIV transmission to others.
We appreciate your feedback! Please write us at pearls@reproductiveaccess.org with any questions, comments or additional resources to add to our list.
Helpful Resources
Medical Eligibility for Initiating Contraception
HIV Drug Interaction Information
Sources
Pharma-free
The Reproductive Health Access Project does not accept funding from pharmaceutical companies. We do not promote specific brands of medication or contraception. The information in the Contraceptive Pearls is unbiased, based on science alone.
