title: Contraceptive options for HIV-positive women: making evidence-based, patient-centred decisions.
abstract: OBJECTIVE
  Women of reproductive age represent a large proportion of the global population living with HIV/AIDS. With improvements in morbidity and mortality since the advent of combination antiretroviral therapy, contraception and pregnancy planning are an increasingly important issue for women living with HIV. This review aims to outline the key considerations when choosing contraceptive methods in HIV-positive women and provides a review of the literature to inform decision-making.
  
  
  METHODS
  Pubmed was searched using the terms 'HIV', 'contraception', 'HIV progression', 'HIV acquisition', 'HIV transmission' and the combination of 'antiretroviral' and 'contraception'. Abstracts were reviewed and relevant articles were retrieved. Reference lists were also reviewed for pertinent citations.
  
  
  RESULTS
  HIV and contraceptive methods can interact in several clinically meaningful ways. Concomitant use may result in altered contraceptive efficacy, drug-drug interactions, or increased toxicity. Hormonal contraceptives have not been shown to affect HIV progression. Notably, the impact of hormonal contraceptives on HIV transmission and acquisition remains unclear, particularly for injectable forms. Data are lacking on several newer methods of contraception including contraceptive rings, patches and intrauterine systems.
  
  
  CONCLUSIONS
  Effective, reliable contraception is important for HIV-positive women. Efficacy, toxicity, drug interactions, and potential impacts on HIV disease progression, transmission, and acquisition must be assessed when making clinical decisions.
authors: Division of Infectious Diseases, University of Toronto, Toronto, Canada.
authors: M
authors: M
authors: Sharma
authors: Division of Experimental Therapeutics - Infection and Immunity, Toronto General Research Institute, Toronto, Canada.
authors: S L
authors: SL
authors: Walmsley
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D003267:Contraception / Q000379:methods; D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use*; D018450:Disease Progression; D004347:Drug Interactions; D005193:Family Planning Services; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*
chemical_list: D044966:Anti-Retroviral Agents; D003278:Contraceptives, Oral, Hormonal
keywords: HIV; HIV transmission; antiretroviral therapy; contraception; sexually transmitted infection