CDC Contraception Recommendations Updated for Women at Risk for HIV

In a recent update published in the Morbidity and Mortality Weekly Report, the Centers for Disease Control and Prevention (CDC) revised its US Medical Eligibility Criteria for Contraceptive Use (US MEC) categorization for depot medroxyprogesterone acetate (DMPA) injection in women at high risk for HIV infection from US MEC category 1 to US MEC category 2.

The US MEC update was based on the recent publication of studies evaluating the impact of hormonal contraception on the risk of HIV acquisition and the recent World Health Organization (WHO) guidance published on the same matter. The review committee was comprised of 8 participants who are experts on family planning and HIV infection, seven of whom were from outside the CDC.¹

After reviewing the available evidence and information regarding contraception and risk of acquiring HIV, the US MEC recommendation for DMPA injections in women at high risk for HIV infection was revised from category 1 (no restrictions) to category 2 (benefits outweigh theoretical or proven risks). The change was in accordance with the recent WHO guidelines.

Implants, progestin-only pills, and combined hormonal contraceptive remained category 1 in the US MEC.

The change in the US MEC stemmed in part from evidence in a systematic review that indicated that women who used DPMA injections were at an increased risk for HIV acquisition (adjusted hazard ratio 1.4, 94% CI 1.2-1.6).² The results across studies were inconsistent, and studies may have had methodologic flaws, according to the authors of the report.¹

The report further stated that the sociodemographic factors that overlap with DMPA use and increased risk for HIV infection are the same globally and in the United States.¹

In an interview with Infectious Disease Advisor, Naomi Tepper, MD, MPH, of the Division of Reproductive Health at the CDC, noted that based on the category 2 recommendation, “women should not be denied the use of DMPA because of concerns about a possible increased risk, but should be counseled about the risks and about how to reduce their risk of acquiring HIV.”

Reference

Tepper NK, Krashin JW, Curtis KM, Cox S, Whiteman MK. Update to CDC’s U.S. medical eligibility criteria for contraceptive use, 2016: revised recommendations for the use of hormonal contraception among women at high risk for HIV infection. MMWR Morb Mortal Wkly Rep. 2017;66:990-994.