Abstract
"U.S. Medical Eligibility Criteria for Contraceptive Use" (U.S. MEC) 2016 provides evidence-based guidance for the safe use of contraceptive methods among U.S. women with certain characteristics or medical conditions (1). The U.S. MEC is adapted from global guidance from the World Health Organization (WHO) and kept up to date through continual review of published literature (1). CDC recently evaluated the evidence and the updated WHO guidance on the risk for human immunodeficiency virus (HIV) acquisition among women using hormonal contraception and intrauterine devices (IUDs) (2). After careful review, CDC adopted WHO's 2019 updated guidance for inclusion in the U.S. MEC guidance; CDC's updated guidance states that progestin-only injectable contraception (including depot medroxyprogesterone acetate [DMPA]) and IUDs (including levonorgestrel-releasing and copper-bearing) are safe for use without restriction among women at high risk for HIV infection (U.S. MEC category 1 [previously U.S. MEC category 2, advantages outweigh risks]) (Box). CDC's guidance also adds an accompanying clarification for women who wish to use IUDs, which states "Many women at a high risk for HIV infection are also at risk for other sexually transmitted diseases (STDs). For these women, refer to the recommendations in the 'U.S. Medical Eligibility Criteria for Contraceptive Use' for women with other factors related to STDs, and the 'U.S. Selected Practice Recommendations for Contraceptive Use' on STD screening before IUD insertion" (1,3). Recommendations for other hormonal contraceptive methods (including combined hormonal methods, implants, and progestin-only pills) remain the same; there is also no restriction for their use among women at high risk for HIV infection (U.S. MEC category 1). Finally, CDC clarified that the U.S. MEC recommendations for concurrent use of hormonal contraceptives or IUDs and antiretroviral use for treatment of HIV infection also apply to use of antiretrovirals for prevention of HIV acquisition (preexposure prophylaxis [PrEP]).
Highlights
The rate of unintended pregnancy is decreasing in the United States, it remains high, with nearly half of pregnancies unintended [4]
Prevention of both unintended pregnancy and human immunodeficiency virus (HIV) acquisition is critical among women at high risk for HIV infection
Daily oral PrEP with the fixed-dose combination of 300 mg of tenofovir disoproxil fumarate (TDF) and 200 mg of emtricitabine (FTC) has been shown to be safe and effective in reducing the risk for sexual HIV acquisition in adults and adolescents weighing at least 77 lbs (35 kg).* PrEP is recommended for HIV prevention for sexually active men and women reporting sexual behaviors that put them at substantial ongoing risk for HIV exposure and acquisition, and for men and women who inject drugs and report injection practices that put them at substantial ongoing risk for HIV exposure and acquisition [15]
Summary
The rate of unintended pregnancy is decreasing in the United States, it remains high, with nearly half of pregnancies unintended [4]. = A condition for which the advantages of using the method generally outweigh the theoretical or proven risks. = A condition for which the theoretical or proven risks usually outweigh the advantages of using the method. = A condition that represents an unacceptable health risk if the contraceptive method is used. HIV infection is associated with adverse pregnancy outcomes for both the mother and child, including increased morbidity during pregnancy and perinatal HIV transmission [6]. Prevention of both unintended pregnancy and HIV acquisition is critical among women at high risk for HIV infection
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