Hormonal Contraception and HIV‐Positive Women: Metabolic Concerns and Management Strategies

Abstract

As HIV-positive women live longer lives, and as testing for HIV becomes more routine, clinicians can expect to see more HIV-positive women in their practices. The need to be aware of management issues particular to this population becomes increasingly important. Metabolic dysregulation is a common, long-term complication associated with HIV and is one of the most difficult to manage. Hormonal contraception also is associated with metabolic dysregulation. As more HIV-positive women choose long-term, reversible contraception, the potential for concomitant and additive side effects, and the need for careful, proactive management strategies to avoid these complications, will become more important. This article reviews research detailing the metabolic dysfunction associated with hormonal contraception and with HIV-seropositivity. It highlights reasons for concern regarding the potential, although as yet theoretical, increased risk for metabolic dysfunction when hormonal contraception is used in the presence of HIV. Suggestions for management strategies for women living with HIV who choose to use hormonal contraception are presented. These strategies should be viewed as suggestions for management until substantitive research becomes available.

HIV Infection and Contraception

“…Although there are concerns about the effect of hormonal contraception on lipid levels, bone metabolism, and insulin and glucose regulation, hormonal contraceptives still present a highly desirable option for many women (Womack et al, 2008). In general, women are more familiar with the hormonal methods and more open toward them.…”

“…Dual energy X-ray absorptiometry scanning at baseline and thereafter at regular intervals should be integrated into the primary care of these women to identify contraindications before ordering DMPA or the subsequent need to modify the women's contraceptive management. In addition, women using this form of contraception should be advised to maintain adequate calcium and vitamin D intake, engage in weightbearing exercise, stop smoking, and decrease their alcohol consumption, which are all important for reducing the risk of osteoporosis (Womack, Richman, Tien, Grey, & Williams, 2008). Because an increasing number of HIV-infected women contemplate childbearing, providers should also pay close attention to recommendations for contraception.…”

Hormonal Contraception and Metabolic Outcomes in Women With or at Risk for HIV Infection

“…HIV disease has been associated with a similar pattern of metabolic dysregulation, and specific antiretroviral drugs may further worsen hypertriglyceridemia, insulin resistance, and glucose tolerance. HC may thus represent an additional risk factor for metabolic dysfunction in HIV-infected women 7. However, few if any studies have explored the impact of HC on metabolic outcomes in the context of HIV infection.…”

Design Features of Drug–Drug Interaction Trials Between Antivirals and Oral Contraceptives

“…HCV‐infected women are strongly encouraged to use contraception methods while receiving ribavirin, a known human teratogen. Women constitute the majority of individuals younger than 25 years of age who are infected with HIV . Women infected with HIV are encouraged to use contraception methods to prevent unintended pregnancies to reduce the risk of fetal transmission of HIV .…”

“…Women constitute the majority of individuals younger than 25 years of age who are infected with HIV. 7 Women infected with HIV are encouraged to use contraception methods to prevent unintended pregnancies to reduce the risk of fetal transmission of HIV. 5 OCs are acceptable if there is no drug-drug interaction (DDI) between OCs and HIV/HCV medications.…”