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Efavirenz use and contraceptive methods in HIV-positive women in a large urban cohort
© Taylor et al; licensee BioMed Central Ltd. 2010
Published: 8 November 2010
Despite increasing reports of successful pregnancies whilst using Efavirenz (EFZ), the drug remains Category C during pregnancy due to concerns around teratogenicity . Additionally, EFZ can render many hormonal methods of contraception less effective. For these reasons, UK guidance suggests that HIV positive women should be informed of these effects before commencing treatment . Following a case in this unit where a young HIV-positive woman had an unplanned pregnancy whilst using Implanon and taking EFZ/Truvada, we examined contraceptive use and advice given to women in our cohort using EFZ, and then instigated changes to improve practice in this area.
Case-note review of all women taking EFZ in Jan 2008 and again in Feb 2010. Current contraception used, advice on teratogenicity, and advice on efficacy documentation was recorded. Women over 50, with documented menopause or hysterectomy were excluded.
Simple changes such as adding contraception to a clinic proforma can help improve sexual and reproductive health outcomes in HIV positive women. However, there are still improvements to be made in documentation of advice given, particularly when using a Category C drug in women who may become pregnant. Additionally, women should be made aware of the potential interaction between antiretrovirals and hormonal contraceptives at the HIV clinic — particularly as some may not disclose their status to Family Planning or GP services and therefore we cannot assume that this advice is being given elsewhere.
This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.