Expanding birth control options for HIV­-positive women

Contraceptive implants are a safe and effective birth control option for HIV­-positive women using anti­retroviral therapy (ART), according to a new UCSF Bixby Center study published in The Lancet HIV. The study helps sheds light on ongoing controversies regarding HIV-positive women’s birth control options.

Using data collected at HIV care clinics in Kenya, the researchers followed nearly 25,000 women for more than two years. They noted the types of contraceptives and ART medications that each woman used. They also tracked when these women became pregnant. The study found that:

  • HIV­-positive women who used implants and efavirenz­-based ART had three times higher rates of pregnancy compared to women who used implants and nevirapine­-based ART.
  • Women on efavirenz­-based ART who used other hormonal contraceptives—such as Depo Provera injections or oral contraceptive pills—had two- to three-times higher rates of pregnancy compared to women using the implant.
  • The only women whose contraceptives were not affected by efavirenz regimens were those who used intrauterine contraceptive devices or had tubal ligations.

This is the first study to comprehensively examine this important topic in the field of HIV and reproductive health. Due to data from previous studies, which showed that the implant’s hormone concentrations in blood were reduced when used with efavirenz-­based ART, some ministries of health in sub­-Saharan Africa have recommended against the use of implants for women taking efavirenz­.

“This study demonstrates that while women on efavirenz­-based ART using the implant have a slightly increased risk of pregnancy, but their risk of pregnancy remained extremely low and was lower than the risk of pregnancy using other reversible contraceptive methods,” said study co-author Dr. Craig Cohen. "Counseling women who are HIV­-positive about family planning options should include this information to help the patient make an informed choice."