Clinical versus laboratory screening for sexually transmitted infections prior to insertion of intrauterine contraception among women living with HIV/AIDS: a randomized controlled trial

U.S. Selected Practice Recommendations for Contraceptive Use, 2024

The 2024 U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR) addresses a selected group of common, yet sometimes complex, issues regarding initiation and use of specific contraceptive methods. These recommendations for health care providers were updated by CDC after review of the scientific evidence and a meeting with national experts in Atlanta, Georgia, during January 25-27, 2023. The information in this report replaces the 2016 U.S. SPR (CDC. U.S. Selected Practice Recommendations for Contraceptive Use, 2016. MMWR 2016;65[No. RR-4]:1-66). Notable updates include 1) updated recommendations for provision of medications for intrauterine device placement, 2) updated recommendations for bleeding irregularities during implant use, 3) new recommendations for testosterone use and risk for pregnancy, and 4) new recommendations for self-administration of injectable contraception. The recommendations in this report are intended to serve as a source of evidence-based clinical practice guidance for health care providers. The goals of these recommendations are to remove unnecessary medical barriers to accessing and using contraception and to support the provision of person-centered contraceptive counseling and services in a noncoercive manner. Health care providers should always consider the individual clinical circumstances of each person seeking contraceptive services. This report is not intended to be a substitute for professional medical advice for individual patients; when needed, patients should seek advice from their health care providers about contraceptive use.

Current and future contraceptive options for women living with HIV

INTRODUCTION

Among women living with HIV, half of the pregnancies are unintended. Effective contraception can prevent unintended pregnancies and consequently reduce maternal mortality and perinatal transmission of HIV. While contraceptive options available for all women also apply to women living with HIV, specific considerations exist to the use of contraception by women living with HIV.

AREAS COVERED

First, general principles guiding the use of contraception among women living with HIV are discussed, such as choice, method mix, relative effectiveness, and drug-drug interactions. Second, a detailed discussion of each contraceptive method and issues surrounding the use of that method, such as drug-drug interactions, follows. Third, future contraceptive options in advanced development for use by women or men are briefly discussed.

EXPERT OPINION

Contraceptive methods available to all women should also be accessible to women living with HIV. When the relative effectiveness of a contraceptive method is reduced, for example due to drug-drug interactions with antiretrovirals, the method should still be made available to women living with HIV with the appropriate information sharing and counseling. Greater research on various aspects of contraceptive use by women living with HIV and more comprehensive testing of co-administration of hormonal contraceptives and common medications used by these women are warranted.

Safety of intrauterine devices among women with HIV: a systematic review

BACKGROUND

Use of highly effective contraception among women living with HIV is critical to prevent unintended pregnancy and subsequent risk of maternal complications and perinatal HIV transmission. However, it is not known whether use of intrauterine devices (IUDs) among women with advanced HIV disease poses an increased risk of pelvic infection or HIV progression and transmission.

OBJECTIVES

To identify evidence regarding the risk of pelvic infection, HIV disease progression or HIV transmission among women with HIV using IUDs and whether this risk differs by severity of HIV disease.

METHODS

We searched the PubMed database for all articles published from database inception through January 2016. For the outcome of pelvic infection, we included studies that examined women using IUDs and reported risk of pelvic inflammatory disease (PID) or pelvic infections among women with varying levels of HIV severity or among women with HIV compared with women without HIV. For the outcomes of HIV disease progression and HIV transmission to noninfected male partners, we included studies of women with HIV using IUDs compared with other contraceptive methods or no method.

RESULTS

The review identified eight articles from six study populations which addressed pelvic infections or other IUD-related complications and found mixed results. One study that directly compared women with varying levels of HIV disease severity found no differences in complication rates between those with severe or mild disease after short- and longer-term follow-up. The remaining studies generally found low or no incidence of PID among IUD users. Among eight articles from seven study populations that reported on HIV disease progression, there were generally no differences between women using IUDs compared with other contraceptives, nor were there changes between baseline and follow-up. One article that reported directly on HIV disease transmission to noninfected male partners found no difference in HIV disease transmission, and five articles found no differences in genital viral shedding among women using IUDs. No direct evidence addresses potential differences in HIV disease progression or transmission by HIV disease severity.

CONCLUSION

Limited evidence of fair to poor quality found no differences in infectious complications when comparing IUD complication rates among women with varying levels of HIV disease severity. One study found that IUD use was not associated with HIV transmission, and studies generally found no differences in genital viral shedding or disease progression; however, there was little direct evidence to address potential differences related to HIV severity.