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Gynecologic Care for Women with HIV Infection

Obstet Gynecol; 2016 Oct; ACOG Committee on Pract Bulletins

The American College of Obstetricians and Gynecologists (ACOG) has issued a practice bulletin on gynecologic care for women and adolescents with human immunodeficiency virus (HIV). The bulletin is intended to educate clinicians about basic health screening and care, family planning, prepregnancy care, and managing common gynecologic problems for women and adolescents who are infected with HIV. Among the (Level A) recommendations offered:

  • Women living with HIV should use condoms to prevent transmission of HIV as well as transmission and acquisition of other sexually transmitted infections (STIs).
  • Women with HIV should take antiretroviral therapy, with the goal of achieving a fully suppressed HIV viral load, for their own benefit and to decrease transmission to uninfected partners.
  • A seronegative male partner of an HIV-infected woman should consider use of antiretroviral pre-exposure prophylaxis with a daily fixed dose of oral tenofovir disoproxil fumarate and emtricitabine to reduce the risk of HIV acquisition.

Level B recommendations include:

  • The copper IUD and levonorgestrel-releasing IUDs can be used by HIV-infected women.
  • Women with HIV should be screened for risk behaviors and offered behavioral interventions annually, and more frequently if necessary, to reduce high-risk sexual and drug behaviors that can transmit HIV.
  • Women with HIV generally should not use vaginal spermicides that contain nonoxynol-9 because they may increase the risk of HIV transmission.
  • Hormonal contraception—including combined hormonal methods (pill, patch, and ring), the progestin-only pill, injection, implant, and levonorgestrel-releasing IUDs—generally is considered safe for use by HIV-infected women, including those who use antiretroviral therapy.

Citation:

Gynecologic care for women and adolescents with human immunodeficiency virus. Practice Bulletin No. 167. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2016;128:e89–110.