The interaction between hormonal contraceptives and antiretroviral therapy (ART), which is used to treat HIV infection, is an important consideration for women living with HIV who use hormonal contraceptives. Here are some key points regarding this interaction:
- Effectiveness of Hormonal Contraceptives: ART does not affect the effectiveness of hormonal contraceptives such as birth control pills, patches, rings, injections, or hormonal intrauterine devices (IUDs). Women living with HIV who are on ART can safely use hormonal contraceptives to prevent pregnancy.
- Potential Drug Interactions: Some antiretroviral medications, particularly certain protease inhibitors and non-nucleoside reverse transcriptase inhibitors (NNRTIs), may interact with hormonal contraceptives and reduce their effectiveness. These interactions occur because both ART and hormonal contraceptives are metabolized in the liver by similar enzyme systems, leading to changes in hormone levels.
- Recommendations for Contraceptive Choice: Women living with HIV who are on ART and use hormonal contraceptives should be counseled about potential drug interactions and advised to choose contraceptive methods that are less likely to be affected by ART. Long-acting reversible contraceptive (LARC) methods such as copper IUDs or progestin-only implants are recommended options because they are not affected by drug interactions and are highly effective at preventing pregnancy.
- Monitoring and Counseling: Healthcare providers should monitor women living with HIV who use hormonal contraceptives and ART closely for any signs of breakthrough bleeding or unintended pregnancy, which may indicate reduced contraceptive effectiveness. Counseling should also include information about the importance of consistent and correct use of contraceptives and adherence to ART to prevent HIV transmission and unintended pregnancy.
- Barrier Methods and Dual Protection: In addition to hormonal contraceptives, women living with HIV and their partners should also use barrier methods such as condoms to prevent the transmission of HIV and other sexually transmitted infections (STIs). Using dual protection (hormonal contraceptives plus condoms) is important for preventing both unintended pregnancy and HIV/STI transmission.
Overall, women living with HIV who use hormonal contraceptives should work closely with their healthcare providers to choose the most appropriate contraceptive method and to ensure that their contraceptive needs are met while also managing their HIV infection effectively with ART.