Hormonal contraceptives are among the most popular and effective methods of family planning. But some studies have suggested that the use of these methods might be associated with an increased risk of acquiring HIV from an infected partner. Scientists also wonder whether HIV-infected users of hormonal contraceptives might be more likely to transmit the virus or whether they might experience an accelerated progression of the disease.
This issue of Network examines these questions and considers the results of the most comprehensive study ever conducted on hormonal contraceptive use and the acquisition of HIV. Based on this evidence, the World Health Organization continues to advise women at risk of acquiring HIV and those who are already infected with the virus that they may safely use hormonal contraceptives.
In this issue
Hormonal Contraception and HIV
According to the largest prospective study ever conducted on hormonal contraception and HIV, women who are at risk of acquiring the virus can safely continue to use hormonal contraceptives. Nevertheless, scientists are still examining other questions about the relationship between hormonal contraception and HIV. For example, do hormonal contraceptives promote the transmission of the virus by HIV-infected women? Do hormonal contraceptives affect the progression of the disease among women who are infected with the virus? For now, scientists suggest that the potential risks of hormonal contraceptive use should be balanced against their known health benefits. All women at risk of acquiring HIV should use condoms correctly and consistently for disease prevention.
Hormonal Contraception and HIV Acquisition
A four-year investigation, involving 6,100 women in three countries, found that the use of hormonal contraceptives does not increase the risk of acquiring HIV. The links below address different facets of this research.
Why This Study is Unique explains why this report is considered to be the most authoritative of its kind.
Questions and Answers provides information about hormonal contraceptives and the design of the study.
Research Implications for Users and Providers offers guidance on applying the study's results, including recommended Actions to Minimize HIV Risks based on a couple's HIV status.
Clients Can Quickly Learn HIV Status discusses rapid HIV tests that provide test results and counseling during a single visit.
Research Implications for Policy-makers explains the need to adopt different approaches depending on the type of HIV epidemic and the relative risk of maternal death and disability.
Balancing Relative HIV and Pregnancy-Related Risks summarizes the policy implications for different situations.
Hormonal Contraception and STI Acquisition Explored
Little is known about the relationship between hormonal contraception and sexually transmitted infections (STIs) other than HIV. There is some evidence that users of combined oral contraceptives or depot-medroxyprogesterone acetate (DMPA) injections may be more likely to acquire chlamydial infections. There is no convincing evidence that users of these methods are more likely to acquire gonorrhea. The evidence linking hormonal contraceptive use and other STIs is insufficient or inconclusive.
Hormonal Contraceptive Use by HIV-infected Women
The article Does Hormonal Contraception Increase HIV Infectivity? explains that scientists don't know whether HIV-infected women who use hormonal contraceptives are more likely to infect their sexual partners. Few studies address this question, partly because scientists aren't sure how to determine a woman's HIV infectiousness.
Likewise, the question Does Hormonal Contraception Speed HIV Progression? also remains unanswered. One study from Kenya suggests that using hormonal contraception at the time of HIV infection may accelerate HIV-related deterioration of the immune system, but this finding has not been confirmed by other studies.
Since pregnancy is thought to suppress immunity, some scientists have raised concerns about its effect on the course of an HIV infection. Does Pregnancy Speed HIV Progression? summarizes evidence suggesting that pregnancy does not accelerate the onset of HIV disease and notes the need for more rigorous research.
Contraceptive Options for HIV-infected Women describes the advantages and disadvantages of various contraceptive methods for women living with HIV who do not want to become pregnant.
In HIV Disclosure Key to Effective Contraception, an experienced HIV counselor from Uganda reports that women's fears of disclosing the results of a positive HIV test makes it difficult for them to use condoms or discuss family planning with their partners.
How Does HIV Therapy Affect Hormonal Contraception?
Because some antiretroviral (ARV) drugs reduce the levels of hormonal contraceptives in the blood, they could theoretically affect their contraceptive efficacy. However, there is no clinical evidence that the use of ARVs increases the number of pregnancies among women who use hormonal contraceptives.
Some scientists have also raised concerns about possible interactions between contraceptive hormones and ARV drugs that might influence a patient's response to ARV therapy. The first study to address the question — described in How Does Hormonal Contraception Affect HIV Therapy? — found that hormonal contraceptive use did not reduce the effectiveness of combined ARV therapy. Larger studies are needed to confirm this finding.
COC-ARV Interactions summarizes the known interactions between oral contraceptives and ARV drugs.
