03 April 2013
A systematic review of peer-reviewed literature found little risk of HIV disease progression in women using hormonal contraception compared with women not using hormonal agents. The one randomized trial reviewed did find a higher progression risk with hormonal contraception than with a copper intrauterine device (IUD).
The investigators searched PUBMED and EMBASE for articles on hormonal contraception and HIV disease progression published in peer-reviewed journals through December 15, 2011. The search yielded 12 reports of 11 studies, including one randomized controlled trial and 10 cohort studies.
The randomized trial found a higher risk of a composite endpoint (lower CD4 count or death) in women who used hormonal contraceptives than in women who used a copper IUD. However, the reviewers detected “important methodological shortcomings” in this trial.
The 10 cohort studies found no increased risk of HIV disease progression among women using hormonal contraception compared with women who did not. These studies measured HIV progression as mortality, time to CD4 count below 200 cells/µL, time to starting antiretroviral therapy, viral load increase, or CD4 count decrease.
The researchers conclude that “the preponderance of evidence indicates that HIV-positive women can use hormonal contraceptive methods without concerns related to HIV-disease progression.”
They add that “prevention of unintended pregnancy among women living with HIV remains a public health priority to safeguard women’s and infants’ health and to prevent vertical transmission of HIV.”
Source: Sharon J. Phillips, Kathryn M. Curtis, Chelsea B. Polis. Effect of hormonal contraceptive methods on HIV disease progression: a systematic review. AIDS. 2013; 27: 787-794.
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