Hormonal Contraception and HIV-Positive Women: Metabolic Concerns and Management Strategies

Authors

  • Julie Womack CNM, APRN, MSN,

    Corresponding author
      Julie Womack, CNM, APRN, MSN, Yale University School of Nursing, 100 Church St. South, P.O. Box 9740, New Haven, CT 06536-0740. E-mail: julie.womack@yale.edu
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    • Julie Womack, CNM, APRN, MSN, is a doctoral candidate at the Yale School of Nursing, New Haven, CT.

  • Susan Richman MD, MPH,

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    • Susan Richman, MD, MPH, is assistant professor at the Yale School of Medicine, and section chief for the Yale Family Planning Program, New Haven, CT.

  • Phyllis C. Tien MD,

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    • Phyllis C. Tien, MD, is assistant professor with the Department of Medicine, University of California, San Francisco, and San Francisco Department of Veterans Affairs, San Francisco, CA.

  • Margaret Grey RN, DrPH,

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    • Margaret Grey, RN, DrPH, FAAN, is dean and Annie Goodrich Professor at the Yale School of Nursing, New Haven, CT.

  • Ann Williams RNC, EdD

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    • Ann Williams, RNC, EdD, FAAN, is a professor of nursing and professor of medicine, Yale University, New Haven, CT.


Julie Womack, CNM, APRN, MSN, Yale University School of Nursing, 100 Church St. South, P.O. Box 9740, New Haven, CT 06536-0740. E-mail: julie.womack@yale.edu

Abstract

As HIV-positive women live longer lives, and as testing for HIV becomes more routine, clinicians can expect to see more HIV-positive women in their practices. The need to be aware of management issues particular to this population becomes increasingly important. Metabolic dysregulation is a common, long-term complication associated with HIV and is one of the most difficult to manage. Hormonal contraception also is associated with metabolic dysregulation. As more HIV-positive women choose long-term, reversible contraception, the potential for concomitant and additive side effects, and the need for careful, proactive management strategies to avoid these complications, will become more important. This article reviews research detailing the metabolic dysfunction associated with hormonal contraception and with HIV-seropositivity. It highlights reasons for concern regarding the potential, although as yet theoretical, increased risk for metabolic dysfunction when hormonal contraception is used in the presence of HIV. Suggestions for management strategies for women living with HIV who choose to use hormonal contraception are presented. These strategies should be viewed as suggestions for management until substantitive research becomes available.

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