Wednesday, November 28, 2012

Hormonal Contraception and HIV

A recently controversial topic. Prof Helen Rees presented at the plenary at the South African HIV CLinician Society Conference in Cape Town November 2012 .
Hormonal methods have an impact on the immune system, in particular injectable contraceptives have raised doubts about their safety and possible increase in risk of transmission of HIV.

Depo has a different impact to nur- isterate (i.e. worse) . Depo provera behaves like a Sledge  hammer
- thins the vaginal epithelial and impacts on vaginal immunity. It may impact on viral load. May be safer for patients to choose Nur-isterate over Depo if they choose Injectable.

There are also drug interactions with ARV s.
Injectable give 2x increase in risk for both partners of acquiring and transmission of infection.
Partners in prevention study. The 3 breds studies all indicate harm.
But it's not simple. Because not using a contraception is also harmful.
Combined oral contraception appear s to be safe.
The problem is with progesterone injections.
WHO assesses the overall quality of the evidence to be low but the better studies tend toward harm (observational data )
It came out with a statement in Feb 2012 highlighting concerning use of Injectables, pills and IUD

So. the Pendulum swings back to where we came from before we had hormonal contraceptives:Intrauterine Devices.
Suggesting use of IUD.  Nur isterate , coc , to decrease dependency on Depo. Now trials will commence. Essential is to combine contraception with hiv prevention and family planning .