TABLE 1. Updated recommendations for contraceptive use by women who are at high risk for human immunodeficiency virus (HIV) infection.
| Condition | Category |
Clarifications/Evidence | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Cu-IUD |
LNG-IUD |
Implants | DMPA | POP | CHCs | ||||
| I | C | I | C | ||||||
| High risk for HIV | 1 | 1 | 1 | 1 | 1 | 1 | 1 | 1 |
Clarification (IUDs): Many women at high risk for HIV are also at risk for other STDs. For these women, refer to the recommendations in the “U.S. Medical Eligibility Criteria for Contraceptive Use” for women with other factors related to STDs and the “U.S. Selected Practice Recommendations for Contraceptive Use” on STD screening before IUD insertion.*,† Evidence (IUDs): High-quality evidence from one randomized clinical trial, along with low-quality evidence from two observational studies, suggested no increased risk for HIV acquisition with Cu-IUD use.§ No studies were identified for LNG-IUDs.¶ Evidence (implants, DMPA, POP): High-quality evidence from one randomized clinical trial observed no statistically significant differences in HIV acquisition between DMPA-IM versus Cu-IUD, DMPA-IM versus LNG implant, and Cu-IUD versus LNG implant.¶,** Of the low-to-moderate-quality evidence from 14 observational studies, some studies suggested a possible increased risk for HIV with progestin-only injectable use, which was most likely due to unmeasured confounding.¶ Low-quality evidence from 3 observational studies did not suggest an increased HIV risk for implant users.¶ No studies of sufficient quality were identified for POPs.¶ Evidence (CHCs): Low-to-moderate-quality evidence from 11 observational studies suggested no association between COC use (it was assumed that studies that did not specify oral contraceptive type examined mostly, if not exclusively, COC use) and HIV acquisition.¶ No studies of patch, ring, or combined injectable contraception were identified.¶ |
Abbreviations: C = continuation; CHC = combined hormonal contraceptive; COC = combined oral contraceptive; Cu = copper; DMPA = depot medroxyprogesterone acetate; I = initiation; IM = intramuscular; IUD = intrauterine device; LNG = levonorgestrel; POP = progestin-only pill; STD = sexually transmitted disease.
* Curtis KM, Tepper NK, Jatlaoui TC, Berry-Bibee E, Horton LG, Zapata LB, et al. U.S. medical eligibility criteria for contraceptive use, 2016. MMWR Recomm Rep 2016;65(No. RR-3).
† Curtis KM, Jatlaoui TC, Tepper NK, et al. U.S. selected practice recommendations for contraceptive use, 2016. MMWR Recomm Rep 2016;65(No. RR-4).
§ Hannaford PC, Ti A, Chipato T, Curtis KM. Copper intrauterine device use and HIV acquisition in women: a systematic review. BMJ Sex Reprod Health 2020;46:17–25.
¶ Curtis KM, Hannaford PC, Rodriguez MI, Chipato T, Steyn PS, Kiarie JN. Hormonal contraception and HIV acquisition among women: an updated systematic review. BMJ Sex Reprod Health 2020;46:8–16.
** Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial Consortium. HIV incidence among women using intramuscular depot medroxyprogesterone acetate, a copper intrauterine device, or a levonorgestrel implant for contraception: a randomized, multicentre, open-label trial. Lancet 2019;394:303–13.