Dual protection with effective contraception and condoms should be central to PCPs’ discussions with young women and couples with HIV who want to avoid pregnancy, according to a clinical report released by the American Academy of Pediatrics.
Published in Pediatrics, the report also recommended that discussions regarding reproductive health be combined with that of HIV care, as achieving an undetectable plasma HIV viral load is essential for the patient’s health, and for a reduction in HIV transmission to partners and children.
“HIV type 1-infected adolescents represent an important subgroup within the adolescent population,” Athena P. Kourtis, MD, PhD, MPH, FAAP, of Emory University, and colleagues wrote. “The availability of combination antiretroviral therapy in the United States has led to increasing numbers of children who acquired HIV infection through mother-to-child transmission who survive into adolescence and young adulthood. In addition, there is also a growing population of horizontally HIV-infected youth. Reproductive health education for pediatric patients, as well as their health care providers, represents an important unmet need in this vulnerable population.”
The clinical report follows a previous AAP recommendation that all pediatricians develop a working knowledge of existing contraceptive methods for adolescents, and an additional report addressing that issue. For the current report, members of the AAP Committee on Pediatric AIDS sought to provide a description and rationale for best practices regarding contraception for adolescents with HIV infection.
The researchers based their report on the AAP technical report on contraception for adolescents, this time focusing on the appropriateness and considerations of various contraception methods. They are presented in general order of effectiveness, starting with the most effective reversible contraceptives, Long-acting reversible contraceptives (LARCs), such as contraceptive implants and intrauterine devices.
The clinical report includes guidance on the following contraceptive methods (in order): Progestin implants, intrauterine devices, progestin-only injectable contraception, combined oral contraceptives, vaginal rings and transdermal patches, progestin-only pills, male condoms, emergency contraception and spermicides, diaphragms and cervical caps.
According to the researchers, the promotion of effective contraceptive methods, combined with education regarding dual protection use, is important among adolescents who are infected with HIV, as it prevents unintended pregnancy, promotes family planning and prevents mother-to-child HIV transmission.
The report also states that several of the antiretroviral drugs used in currently recommended regimens for adults and adolescents have interactions with some hormonal contraceptives, limiting their efficacy. The evidence regarding these interactions and their clinical significance is still emerging, according to the report.
“Clinics and physician practices providing primary care for HIV-infected female adolescents need to include comprehensive reproductive health counseling and care, and have the capability to provide appropriate contraceptive guidance, delivery and monitoring,” Kourtis and colleagues wrote. “Addressing adolescent reproductive health issues in the medical home and during routine visits, where family planning services are integrated into care, along with antiretroviral therapy adherence and risk-reduction counseling, may be one of the best ways to address the sexual and reproductive health needs of HIV-infected adolescents.” – by Jason Laday
Disclosure: The researchers report no relevant financial disclosures.