High-quality, individualized reproductive health care is especially important for adolescents and young adults with human immunodeficiency virus (HIV) to prevent unintended pregnancies, sexually transmitted infections (STIs) and secondary transmission of HIV to partners and children.
Counseling also is critical because several antiretroviral (ARV) drugs used in recommended regimens interact with some hormonal contraceptives, which may limit the contraceptives’ efficacy.
The findings are included in a new AAP clinical report Contraception for HIV-Infected Adolescents from the Committee on Pediatric AIDS. Available at http://dx.doi.org/10.1542/peds.2016-1892, the report is published in the September issue of Pediatrics. It offers an updated review of reproductive health issues specific to HIV-infected teens; issues on confidentiality and consent; methods of contraception; and interactions of hormonal contraception and ARV drugs. A table summarizes the evidence on interactions with hormonal contraceptives by ARV class.
Dr. KourtisHIV-infected teens need to have their family planning needs addressed by their primary care providers, always with an individualized approach that considers the teen’s preferences and personal situation, said Athena P. Kourtis, M.D., Ph.D., M.P.H., FAAP, a lead author of the report.
There are many good contraceptive options for HIV-infected female teens, despite some pharmacologic interactions of some options with some ARV drugs, she noted.
“Experts in HIV care can always be consulted if specific questions arise about particular methods,” Dr. Kourtis said.
In general, the most effective reversible contraceptive methods are the long-acting reversible contraceptive (LARC) methods (contraceptive implants and intrauterine devices). LARC methods usually are ideal for adolescents because they are user-independent options that eliminate the need for regular adherence for effectiveness, the report said. They can be helpful for the many HIV-infected teens who already grapple with daily adherence to combination ARV therapy.
While evidence still is emerging on pharmacologic interactions, the report noted that nucleoside reverse transcriptase inhibitors and entry inhibitors don’t appear to have significant interactions with hormonal contraceptive methods.
Health care providers should integrate reproductive and HIV care discussions, the report noted, because reduction of plasma HIV viral load below the level of detection is “essential for the individual’s health as well as for reduction of HIV transmission to partners and children.”
In counseling patients, pediatricians should emphasize the need for dual protection (effective contraception along with condoms), which is critical for HIV-infected young women and couples wishing to avoid pregnancy. Condoms are necessary to prevent transmission of HIV and other STIs to sexual partners.
Dr. Mirza“Contraception should be individualized for each patient,” said Ayesha Mirza, M.D., FAAP, one of the lead authors, “and that discussion needs to take place between the physician and patient.”
An ongoing dialogue may be necessary before an agreement is reached to ensure that the contraception method selected has a chance of being successful and that compliance is good, she added.
Parental involvement also is desirable, Dr. Mirza said, after discussion with and consent by the adolescent.
Although most new HIV infections among youths occur in gay and bisexual males, female youths remain vulnerable, with blacks and Hispanic/Latino youths experiencing higher rates of HIV infection than others.
Data show that a majority of 15- to 24-year-olds in the U.S. don’t perceive they are at risk of acquiring HIV and are unlikely to protect themselves, according to the report. In addition, more than 60% of HIV-infected youths in the U.S. do not know they are infected.
“Reproductive health education for pediatric patients as well as their health care providers represents an important and unmet need in this vulnerable population,” the report concludes.
