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Dr. Jim Shelton's Pearls "Pearl" for the week of January 22, 2004

Medical Reasons to Offer Contraception Along with ART

Women taking ARVs may have a variety of reasons either to avoid pregnancy, or conversely to become pregnant. But are there medical concerns about becoming pregnant while on ARVs?

Yes both for the fetus and the woman. Notably, the drug Efavirenz (EFZ) which is a current favorite (it is included in 2 of the 4 first-line ARV combinations currently recommended by WHO and specifically recommended for
those with TB co-infections), is believed to be a potent early teratogen (an agent that may induce birth defects). In fact, recent WHO draft guidance states:

"EFZ should not be given to women of childbearing potential unless effective contraception can be assured."

The various other ARVs are not known to be teratogenic, but neither are they known to be entirely safe, so the possibility of an effect on the fetus remains with them as well.

Additionally, while pregnancy does not appear to hasten HIV progression, it is clearly an important additional stress on the body above and beyond the effects of the HIV, possible co-infections and typically 3 potent ARVs. Also the adverse effects of ARVs may compound those of pregnancy. For example, certain ARVs can cause anemia or insulin resistance, which also tend to worsen in pregnancy. Moreover there is some evidence that HIV may be associated with adverse pregnancy outcomes such as low birth weight.

References:

1. WHO, Scaling up antiretroviral therapy in resource-limited settings: Treatment guidelines for a public health approach, 2003 draft version, Geneva 2003.
2. Minkoff H et al. The relationship of pregnancy to human immunodeficiency progression. Am J Ob Gyn 2003;189:552.
3. Leroy V et al. Effect of HIV-1 infection on pregnancy outcome in women in Kigali, Rwanda, 1992-1994. Pregnancy and HIV Study Group. AIDS 1998;12:643.
4. Ticconi C et al. Effect of maternal HIV and malaria infection on pregnancy and perinatal outcome in Zimbabwe. JAIDS 2003;34:289.

The "Pearls" offer answers to commonly asked questions about family planning. These "Pearls" are prepared by Dr. James D. Shelton, Senior Medical Scientist, Office of Population, United States Agency for International Development (USAID)

Disclaimer: The information provided on this web site is not official U.S. Government information and does not represent the views or positions of the U.S. Agency for International Development, the U.S. Government or The Johns Hopkins University.