THAC0505LB - Oral Abstract Session
HIV and contraception - complex issues for safe choice: the latest recommendations from the World Health Organization (WHO)
Presented by Mary E Gaffield (Switzerland).
M.E. Gaffield1, S.J. Philips1, R.C. Baggaley2, P. Steyn1, M. Temmerman1
1World Health Organization, Reproductive Health and Research, Geneva, Switzerland, 2World Health Organization, HIV/AIDS, Geneva, Switzerland
Background: Women living with or vulnerable to HIV, face an ongoing debate and confusion regarding the safety of various contraceptives. Three key questions are raised: 1) Does hormonal contraception (HC) increase HIV risk? 2) Does HC accelerate disease progression among HIV-positive women or affect transmission to seronegative male partners? 3) Do drug interactions between certain ARVs and HC reduce efficacy of either?
Methods: Four systematic reviews of epidemiological, clinical, and pharmacological evidence available through 15 January 2014 were conducted to inform the WHO''s Medical eligibility criteria for contraceptive use guideline.
Results: 22 studies assessed HIV acquisition risk among HC users; 9 were considered “informative with important limitations,” or higher-quality. No consistent or significant association between the use of oral contraceptives and increased risk of HIV acquisition was noted among 8 studies considered to be of higher quality. Among 7 higher quality studies examining injectable contraceptive use, some showed an increase in risk while others failed to show a difference in HIV acquisition. Ten studies reported no affect between HC and HIV disease progression; one study found an association. One study showed an increased risk of female-to-male transmission, another did not. Thirty-nine studies generally report reassuring results regarding drug interactions between HC and ARVs. DMPA excepted, limited data suggests concomitant use of Efavirenz, Nevirapine, and some protease inhibitors may lower HC effectiveness.
Conclusions: New WHO guidance recommends no restrictions on the use of combined hormonal contraceptives (pills, patch, vaginal ring, or injectable) or progestogen-only contraceptives (pills, injectable, or implants) for women with or vulnerable to HIV. Women taking ART are now generally eligible for all HC methods, although special consideration may be necessary. Because any risk of HIV acquisition associated with progestogen-only injectable use remains on open question, women and couples at high risk of HIV infection should be informed about (and have access to) HIV preventative measures, including male and female condoms. WHO is committed to continually review its recommendations in light of the accumulating evidence, and strongly supports the need for further research to identify definitive answers that address concerns around increased biological vulnerability to HIV among women using progestogen-only injectables.
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