Previous studies have indicated that one in five women with HIV infection are not using any contraceptive method, a rate which is higher than in the general population. High rates of unintended pregnancies have been reported in some settings with proportions ranging from 50-85%, with condoms often being the most commonly used contraceptive method. ^[5]

It is important to offer all women with HIV infection who do not desire a pregnancy, effective and appropriate methods to reduce the risk of an unintended pregnancy. Women with HIV infection can use all available contraceptive methods, including hormonal contraception, emergency contraception and long-acting reversible contraceptives (LARCs). The method of contraception to be used should be chosen in discussion with the woman, and should be acceptable and medically appropriate with consideration of thrombosis, cardiovascular disease and stroke risk, together with worsening of migraine on combination hormonal contraceptives. ^[6]

A World Health Organization expert panel has reviewed all available evidence regarding hormonal contraception and the potential effect on HIV transmission to a partner without infection and has recommended that women with HIV infection can use all available hormonal contraceptive methods without restriction. ^[7]

Many of the older antiretroviral drugs have inducing or inhibiting effects on the cytochrome P450 enzyme system and, as hormonal contraceptives are metabolised by cytochrome P450 isoenzymes, there are significant drug-drug interactions between hormonal contraceptives and antiretroviral drugs, which may lead to contraceptive failure. ^[8] This is not a problem with currently available integrase inhibitor drugs. Detailed descriptions of interactions are available in existing antiretroviral guidelines. ^[9] A practical guide is summarised below (Table 3). It should be noted that data on drug-drug interactions between antiretroviral drugs and hormonal contraceptives are primarily derived from drug labels and there are limited studies of the clinical significance of these interactions. The magnitude of change in contraceptive efficacy may not be well known in all instances.

IUDs appear to be a safe and effective contraceptive option for women with HIV. Studies have primarily focussed on IUDs which do not contain hormones (e.g., copper IUDs) several small studies have shown that levonorgestrel-releasing IUDs are safe and have no associated increased genital tract shedding of HIV.