Contraceptive Counseling Key for HIV-infected Girls

Primary care physicians and clinics who care for adolescent girls infected with human immunodeficiency virus (HIV) need to provide reproductive health counseling and appropriate contraceptive guidance, delivery, and monitoring, according to a new clinical report from the American Academy of Pediatrics (AAP).

The report’s goal is “to provide a description and rationale for best practices in counseling and administering contraception for adolescents with HIV infection.”

The availability of combination antiretroviral therapy in the United States has led to increasing numbers of children who acquired HIV infection through mother-to-child transmission and survive into adolescence and young adulthood. In addition, there is a growing population of horizontally HIV-infected youth, stated the AAP Committee on Pediatric AIDS.

HIV type 1–infected adolescents represent an important subgroup within the adolescent population. More than 60% of American HIV-infected youth do not know they are infected, it was noted.

Clinicians face several barriers to providing sexual and reproductive health education, including overbooked clinics and large patient loads that limit the time available for individual consultations. “In some cases, lack of adequate training on how to effectively provide sexual and reproductive health education and discuss these topics with minors presents an additional barrier,” the report stated.

Effective contraception is important for sexually active HIV-infected adolescents to prevent unintended pregnancy, promote family planning, and prevent mother-to-child transmission of HIV. However, “several of the antiretroviral drugs used in currently recommended regimens for adults and adolescents in the United States have interactions with some hormonal contraceptives, which may limit their efficacy,” the committee wrote, and evidence of pharmacologic interactions of these contraceptives is still emerging.

In particular, interactions of long-acting reversible contraceptives with antiretroviral agents are particularly important because they are among the most effective contraceptive methods. In addition, the effect of hormonal contraceptives on local cervicovaginal concentrations of antiretroviral drugs administered topically or systemically will also need to be studied, they wrote.

“There is a need for the development of long-acting, safe, multipurpose prevention technologies that address multiple sexual and reproductive health needs of adolescents and young adults as well as decreased user adherence requirements. Such proof-of-concept technologies might include genitally applied products that can afford antiviral and contraceptive activity and have longer duration of action,” they stated.

HIV-infected adolescent females need comprehensive reproductive health counseling and care that should include appropriate contraceptive guidance, delivery, and monitoring, they stated. “Encouraging abstinence, delay of sexual initiation, correct and consistent condom use, and adherence to the antiretroviral regimen are important strategies to improve adolescents’ health, prevent unintended pregnancies, and prevent HIV transmission to partners,” they wrote.

The committee suggested that “addressing adolescent reproductive health issues in the medical home and during routine visits, where family planning services are integrated into care, along with antiretroviral therapy adherence and risk-reduction counseling, may be one of the best ways to address the sexual and reproductive health needs of HIV-infected adolescents.”

The report was published in the September 2016 Pediatrics.