Effect of hormonal contraceptive methods on HIV disease progression: a systematic review

Phillips, Sharon J.a; Curtis, Kathryn M.b; Polis, Chelsea B.c

AIDS:
doi: 10.1097/QAD.0b013e32835bb672
Epidemiology and Social
Abstract

Objective: Systematically assess from the literature whether women living with HIV who use hormonal contraception are at increased risk of HIV-disease progression compared with those who do not use hormonal contraception.

Methods: 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 11 studies met inclusion criteria. One randomized controlled trial (RCT) found increased risk for the composite outcome of a reduced CD4 cell count or death among hormonal contraceptive users when compared with copper intrauterine device (IUD) users. Ten cohort studies reported no increased risk for HIV disease progression (as measured by mortality, time to a CD4 cell count below 200, time to initiation of antiretroviral therapy, an increase in HIV-RNA viral load, or a decrease in CD4 count) among women who used hormonal contraception compared with those who did not.

Conclusion: The preponderance of evidence indicates that HIV-positive women can use hormonal contraceptive methods without concerns related to HIV-disease progression. Cohort studies consistently found no association between hormonal contraceptive use and HIV-disease progression compared with nonuse of hormonal contraceptives. 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. 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.

Author Information

aDepartment of Reproductive Health and Research, World Health Organization, Geneva, Switzerland

bDivision of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia

cOffice of Population and Reproductive Health, United States Agency for International Development, Washington, DC, USA.

Correspondence to Sharon Phillips, Department of Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland. Tel: +41 22 791 15 23; fax: +41 22 791 4171; e-mail: phillipss@who.int

Received 13 July, 2012

Revised 11 October, 2012

Accepted 19 October, 2012

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© 2013 Lippincott Williams & Wilkins, Inc.