HIV/AIDS Treatment and Care : Clinical protocols for the European ...

support for sexual and reproductive health in people living with hiv
3.1.4. Other barrier methods (diaphragms, cervical caps)
Women for whom pregnancy is an unacceptable risk should be advised that other contraceptive
barrier methods (diaphragms and cervical caps) may not be appropriate because of their relatively
higher typical-use failure rates for those who cannot use them consistently and correctly. It should
also be stressed that they do not protect against the transmission of HIV or other STIs.
3.1.5. Spermicides
• Since nonoxynol-9 may cause some side-effects, condoms lubricated with it should no longer
be promoted; nevertheless, it is better to use a nonoxynol-9-lubricated condom than no condom
(60).
• The safety concerns with nonoxynol-9 also apply to other spermicidal products marketed for
contraception. Spermicides should not to be used by women living with HIV, neither alone or
with other barrier methods such as diaphragms or cervical caps.
• There is no evidence that nonoxynol-9-lubricated condoms provide any more protection against
pregnancy or sexually transmitted infections than condoms lubricated with silicone.
3.2. Low-dose combined oral contraceptives (COC)
Table 7.
low-dose coc (≤35 μg of ethinylestradiol (ee)) for
women living with hiv
Status Categorya Comment
High risk of
HIV
HIV/AIDS
without ART
HIV/AIDS +
ART
1 Overall, evidence is inconsistent regarding whether there is any increased risk of HIV
acquisition among COC users.
1 Limited evidence suggests no association between COC use and changes in RNA levels
or CD4 counts among HIV-infected women. There is also limited evidence showing no
association between COC use and female-to-male HIV transmission, and mixed results
regarding increased risk of HIV and HSV shedding among HIV-infected women using
hormonal contraception.
2 For women on ART, refer to the section on drug interactions below (V.4.1). As there
may be drug interactions between hormonal contraceptives and ARVs, such use is classified
as Category 2.
Drug interactions
ARVs 2 It is important to note that ARV drugs have the potential to decrease or increase the
bioavailability of steroid hormones in hormonal contraceptives. The limited data available
suggest that interactions between many ARVs (particularly some NNRTIs and PIs)
and hormonal contraceptives may alter the safety and effectiveness of both. For women
initiating or continuing hormonal contraceptive use while on ART, the consistent use of
condoms is recommended for preventing HIV transmission; it may also compensate for
any possible reduction in the effectiveness of the hormonal contraceptive. See section
V.4 below.
a Category 1: no restrictions for use of contraceptive method; use in any circumstances. Category 2: advantages of using method
generally outweigh theoretical or proven risks. Generally advisable to use the method.
Note: COCs do not protect against HIV/STIs. If there is risk of HIV/STIs, the correct and consistent use of condoms is recommended,
either alone or with another contraceptive method. Male latex condoms are proven to protect against HIV/STIs.
Source: WHO (50).
There are concerns that women may have a greater risk of acquiring STIs when using hormonal
contraceptives, possibly due to decreased condom usage. Yet the evidence is inconsistent regarding
whether hormonal contraceptive users have greater risk of acquiring HIV than non-users (50).
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