Abstract

WEAC0204 - Oral Abstract Session

Hormonal contraception and HIV disease progression: a systematic review of the epidemiological evidence

Presented by Sharon Phillips (Switzerland).

S. Phillips¹, K. Curtis², C. Polis<sup>3

1</sup>World Health Organization, Reproductive Health and Research, Geneva, Switzerland, ²Centers for Disease Control & Prevention, Division of Reproductive Health, Atlanta, United States, ³US Agency for International Development, Office of Population and Reproductive Health, Washington, United States

Background: Prevention of unintended pregnancy remains a key concern for women living with HIV, both as a core strategy to prevent mother-to-child transmission of HIV and to decrease maternal and neonatal morbidity and mortality through lower birth rates, improved birth spacing, and lower rates of unsafe abortion. However, there are theoretical concerns about the effect of various contraceptive methods on HIV disease progression.
Methods: We conducted a systematic review to determine whether HIV-infected women who use hormonal contraception are at increased risk of HIV disease progression compared with those who do not use hormonal contraception. We searched PUBMED and EMBASE for articles published in peer-reviewed journals through December 15, 2011 for evidence relevant to all hormonal contraceptive methods and HIV disease progression.
Results: Twelve reports of eleven studies met inclusion criteria. One randomized controlled trial (RCT) found increased risk of a composite outcome of declining CD4 count or death among hormonal contraceptive users when compared with copper IUD users. Ten observational studies reported no increased risk of HIV disease progression, as measured by mortality, time to CD4 below 200, time to initiation of antiretroviral therapy, increased HIV-RNA viral load, or decreased CD4 count with hormonal contraceptive use compared with non-use.
Conclusions: One RCT found that hormonal contraceptive use was associated with increased risk of HIV disease progression when compared with IUD use, but this study had important methodological shortcomings. Cohort studies consistently found no association between hormonal contraceptive use and HIV disease progression compared with non-use of hormonal contraceptives. Thus, the preponderance of evidence indicates that HIV-positive women can use hormonal contraceptive methods without concerns related to HIV disease progression. Prevention of unintended pregnancy through safe and effective contraceptive use among women with HIV remains a public health priority to safeguard maternal health and prevent mother-to-child transmission of HIV.