The Centers for Disease Control and Prevention (CDC) has adopted the World Health Organization’s (WHO) updated guidelines from 2019 regarding birth control use among women at risk for HIV, which establish that two major forms of contraception do not increase such risk in this population.
The CDC’s new stance applies to progestin-only injectable contraception, including Depo-Provera (depot medroxyprogesterone acetate), and intrauterine devices (IUDs), including levonorgestrel-releasing and copper-bearing devices. These birth control methods, according to the health agency, “are safe for use without restriction among women at high risk for HIV infection.”
CDC researchers published this update to the agency’s 2016 recommendations on birth control for women with certain characteristics and medical conditions in the Morbidity and Mortality Weekly Report.
The CDC also recommends no restrictions on the use of other birth control methods for women at high risk for HIV, including combination hormonal methods, implants and progestin-only pills.
In weighing whether to adopt the WHO guidelines, the CDC considered an updated systematic review on hormonal contraception and HIV risk among women that included 36 studies, 17 of which met the minimum quality criteria as defined in the review. The agency also considered a systematic review of copper IUD use and HIV risk that contained seven studies, three of which met the minimum quality criteria.
The primary source of new evidence was the randomized ECHO trial conducted in sub-Saharan Africa, which compared HIV acquisition rates among some 7,800 women assigned to receive Depo-Provera, levonorgestrel implants or copper IUDs. HIV acquisition rates did not differ significantly based on which form of contraception the women received.
“Women at high risk for HIV are eligible to use all hormonal contraceptive methods and intrauterine devices,” the CDC concluded. “Recommended HIV infection prevention measures, including pre-exposure and post-exposure prophylaxis, limiting number of sexual partners and correct and consistent use of condoms, should be strongly encouraged among all women at high risk for HIV acquisition and should be integrated into family planning services.”
To read the MMWR report, click here.