• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • 0 CME Hours
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
GYN

Optimizing Contraception for the HIV-positive Woman

image_pdfFavoriteLoadingFavorite

The ideal contraceptive for an HIV-positive woman prevents pregnancy as well as transmission of HIV and STDs.  Dual contraception using condoms plus an additional contraceptive appears to be the best strategy.

CLINICAL ACTIONS:

The following represent good contraceptive choices in addition to condoms:

  • Combined hormonal contraception (pill, patch and ring) and progestin-only pills may decrease hormone levels in women taking some antiretroviral therapies, but are still considered safe (MEC cat. 2)
    • If the patient is on fosamprenavir, avoid hormonal contraception; it may reduce efficacy of the antiretroviral
  • Contraceptive implants are highly effective and benefits outweigh risks in HIV positive women (MEC cat. 2)
    • Theoretical interactions between multiple antiretrovirals and implants may reduce effectiveness
  • Injectable depot medroxyprogesterone acetate (DMPA) is safe and effective (MEC cat. 1) and does not appear to have interactions with antiretrovirals
  • Intrauterine devices, both copper containing and levonorgestrel-releasing, are safe (MEC cat. 1) for women with HIV, with no known drug interactions with antiretrovirals
    • Limited data suggest a low risk of pelvic inflammatory disease and no changes in genital shedding of HIV RNA

SYNOPSIS:

Condoms effectively reduce transmission of HIV between discordant partners but do not represent optimal contraception, with an annual pregnancy rate of over 15% per year. Dual contraception with any of the above options are safe in HIV positive women, assuming they meet the usual health criteria for use.  Counseling should emphasize that use of any contraception does not take the place of condom use for prevention of transmission.

KEY POINTS:

  • HIV infection does not pose a barrier to sterilization, which remains an appropriate contraceptive option
  • Emergency contraception including hormone based (progestin-only pills, ulipristal acetate, combined oral contraceptives) and the copper IUD should be offered to HIV positive women whenever appropriate
  • Spermicides and diaphragms with spermicide are not recommended
    • Nonoxynol-9, the active ingredient in most formulations, may increase the likelihood of HIV transmission to a partner
  • Diagnosis codes:
    • HIV infection: Z21
    • Encounter for contraception management: Z30.09

Learn More – Primary Sources:

ACOG Practice Bulletin 167: Gynecologic Care for Women and Adolescents With Human Immunodeficiency Virus

CDC United States medical eligibility criteria for contraceptive use, 2016

Contraception: Contraceptive failure in the United States

image_pdfFavoriteLoadingFavorite

< Previous
All GYN Posts
Next >

Related ObG Topics:

Cervical Cytology and HPV Screening in the HIV Positive Woman
Screening & Treatment of Gynecologic infections in the HIV-Positive Woman
Ulcerative Genital Conditions in the HIV-Positive Woman

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • #Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

ObG Library

  • Hysteroscopy
  • Fertility
  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Log In to ObG First

Please log in to access OBGFirst and the 2T Ultrasound Atlas

Password Trouble?

Sign Up for ObGFirst

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!

ObG First Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site