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3–48 | Clinical Manual for Management of the HIV-Infected Adult/2006
Table 5. Advantages and Disadvantages of Various Contraceptives
Contraceptive Type Advantages Disadvantages
Barrier Methods
Male and female condom • Protect against • Requires partner cooperation and correct technique
transmission of HIV
and STDs
• High failure rate when used incorrectly
Diaphragm and cervical cap • Requires partner cooperation and correct technique
• High failure rate when used incorrectly
Sponge • Does not prevent STD or HIV transmission
Hormonal Methods • Do not prevent STD or HIV transmission
Oral* • Very effective
• Lighter menstrual
flow
Injectable depot
medroxyprogesterone acetate
(DMPA, Depo-Provera)
Transdermal/Patch • Effective
• Lighter menstrual
flow
Vaginal ring • Effective
• Lighter menstrual
flow
Intrauterine devices (IUDs) • Effective for longterm
use
• No evidence of
increased HIV viral
shedding
Surgical Methods
•
•
•
May have significant drug-drug interactions with protease inhibitors (PIs) and
nonnucleoside reverse transcriptase inhibitors (NNRTIs) that may affect the efficacy
and toxicity of estradiol and norethindrone, and of certain PIs*
Consider alternative methods for women taking PIs or NNRTIs
Some concern about increased cervical proviral shedding
• Effective
• Possible increased risk of genital tract HIV shedding
contraception for 3
months
• Long-term concern about osteoporosis
• No studies to document pharmacokinetic interactions, but possible significance
• Possible increased risk of HIV viral shedding
• No studies to document pharmacokinetic interactions, but possible significance
• Possible increased risk of HIV viral shedding
• Possible blood loss with Copper T IUD
Bilateral tubal ligation (female) • Effective;
• Does not prevent STD or HIV transmission
permanent
• No future fertility (usually not reversible)
Vasectomy (male) • Effective;
• Does not prevent STD or HIV transmission
permanent
• No future fertility (usually not reversible)
Spermicides
Spermicides • Not currently recommended
•
•
Nonoxynol-9 increases risk of HIV transmission
Do not prevent STD or HIV transmission
* See chapter Antiretroviral Medications and Oral Contraceptive Agents and U.S. Department of Health and Human Services. Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents.
October 10, 2006. Available online at aidsinfo.nih.gov/Guidelines/GuidelineDetail.aspx?GuidelineID=7.