Hormonal Contraceptives and HIV
October 2010—HIV is the leading cause of mortality among women of reproductive age worldwide.1 In 2008, an estimated 1.4 million pregnant women living with HIV in low- and middle-income countries gave birth. About 40 percent of the people living with HIV in Southeast Asia are women.2
For HIV-positive women who wish to prevent pregnancy, use of an effective contraceptive improves their ability to make their own reproductive choices, reduces demand for abortions, and lowers the risks of maternal morbidity and mortality. It also reduces the number of infants born with HIV.3 However, there has been some controversy over the safety of using hormonal contraceptives (i.e., oral contraceptive pills and hormone injections) together with antiretroviral therapy, as some drug interactions can reduce the effectiveness of these birth control methods. In addition, previous studies in animals and humans have suggested that hormonal contraception may accelerate HIV disease progression.
A recent retrospective analysis is the largest yet published to examine the issue of combining ART and hormonal contraceptives. The study, which used data collected over more than 10 years from 625 Ugandan women who had recently been diagnosed with HIV, found that 27.5 percent (172) reported using hormonal contraceptives at some point during the follow-up period. Of the total study population, 29.9 percent (291) progressed to AIDS and 16.6 percent (104) died during observation. The median time from initial HIV diagnosis to AIDS diagnosis was 4.5 years and from HIV diagnosis to death, 7.06 years.
Investigators found that hormonal contraceptive use was not associated with faster progression to death. In fact, in this group of women, the use of hormonal contraceptives was associated with a reduced risk of disease progression to AIDS or death, compared to women using no contraceptive. There was no difference in disease progression between women who used hormonal contraceptives and those who used non-hormonal methods (e.g., condoms, diaphragms, or intrauterine devices).3
The results of this study may help HIV-positive women and healthcare providers make more informed decisions about using birth control. Identifying safe and effective methods of contraception will support the reproductive health needs of HIV-positive women and can reduce the number of infants exposed to HIV.
1. WHO, Women and Health: Today's Evidence Tomorrow's Agenda. 2009; 43.
2. WHO, UNAIDS, UNICEF, Towards Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector Progress Report. 2009; 88–89.
3. Polis CB, et al. Effect of hormonal contraceptive use on HIV progression in female HIV seroconverters in Rakai, Uganda. AIDS. 2010 Jul; 24(12) 1937–44.