Hormonal contraceptive use in HIV-infected women using antiretroviral therapy: a systematic review

Background: While extensive research has explored pharmacokinetic interactions between antiretroviral therapy (ART) and hormonal contraception few studies have examined whether these interactions affect clinical outcomes. To address this gap we conducted a systematic review of the literature that describes hormonal contraceptive use among HIV-infected women who also use ART focusing on papers that address clinically important outcomes such as pregnancy or ovulation. Methods/design: An electronic literature search was conducted of PubMed and Ovid to identify all articles that addressed hormonal contraception co-administered with ART published in English between January 1 1990 and October 30 2014. In addition manual reference checks of all articles of interest were conducted to identify articles not captured in the electronic search. Our search criteria identified 405 records. The title and abstract of data reports retrieved via the search were reviewed to identify potential articles of interest. Those with any indication of the main outcomes of interest were considered for inclusion (N=162). Abstracts were then reviewed to identify those manuscripts that would merit a review of the full-text version (N=64). Eight articles that addressed the outcomes of interest were identified. The Newcastle-Ottawa Scale was used to assess the quality of these articles. Results: The studies reviewed were limited in a number of ways that precluded their providing a rigorous assessment of the efficacy of contraception when co-administered with ART. Discussion: None of the studies were of adequate quality to provide the guidance that providers and HIV-infected women need when considering contraceptive options. High-quality well-powered studies are required to address the efficacy of hormonal contraception when co-administered with ART.