Human Immunodeficiency Virus infection, contraception and sexuality: what do we (not) know?
ESC Congress Library. Machado L. May 28, 2014; 50491; A-075
Dr. Luísa Machado
Dr. Luísa Machado
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Abstract
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Objective: With the increasing number of women of childbearing age infected by the human immunodeficiency virus (HIV), it is essential to provide them the information and education required to make an informed choice about pregnancy, contraception and transmission prevention. The aim of this study is to characterize a portuguese population of HIV-infected women, regarding sexuality and contraceptive methods and to review the eligibility criteria of the contraceptive methods.
Design and methods: Women infected with HIV observed in a gynecology consultation at a tertiary hospital, between February 2011 and May 2013, were evaluated regarding demographic, clinical, sexual and contraceptive data.
Results: 269 HIV-infected women were analyzed. The mean age at HIV diagnosis was 36.7 ± 12.4 years, and the mean age of patients during the study was 46.9 ± 12.4 years. The main route of HIV transmission (80%) was intercourse, 86% patients had less than 5 lifetime sexual partners and 41% were sexually active before the age of 18 years. 41.5% had history of sexual transmitted infections (STI) and 33% are current smokers (17% smoked more than 15 cigarettes). The majority of women were on antiretroviral treatment, had levels of CD4 lymphocytes more than 200 and indetectable circulating HIV viral loads (87.6%, 91.8% and 76.4% respectivelly). 68% were of childbearing age and 51% were serodiscordant couples. The most common contraceptive method was the male condom (30.4%), followed by female sterilization (23.3%), combined hormonal contraception (CHC, 15.8%), subcutaneous implant (5.8%) and intrauterine device (IUD, 4.1%). A dual contraception occurred in 21.6%, and the overall use of condoms in childbearing age was 52.6%. A lower condom use was associated with smoking, menopause, seroconcordance and sterilization (p <0.05); no relation was found with the level of education, history of other STI, CD4+ counts or viral load. With increasing age we found a lower condom use, CHC and subcutaneous implant; and a greater use of IUDs, option for tubal ligation or no method.
Conclusions: A significant number of HIV-infected women chose a permanent method, but the use of reversible forms of contraception was more common and has been increasing. Most contraceptive methods are safe and effective in HIV-infected women, despite some of them haven´t been conveniently tested. However, dual protection remains the best option to prevent unintended pregnancy and minimize the risks of transmission.

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