A practical clinical guide to counselling on and managing contraception, pre-conception planning, and menopause for women living with HIV

Author:

Cvetkovic Anna1,King Elizabeth2,Skerritt Lashanda3,Loutfy Mona456,Tseng Alice7,Murray Melanie28,van Schalkwyk Julie89,Boucoiran Isabelle10,Marcotte Suzanne11,Hankins Catherine12,Savoie Édénia13,de Pokomandy Alexandra13,Pick Neora28,Tkachuk Stacey8,Rowe Timothy9,Smaill Fiona1,Walmsley Sharon45

Affiliation:

1. Department of Medicine, Division of Infectious Diseases, McMaster University, Hamilton, Ontario, Canada

2. Department of Medicine, Division of Infectious Diseases, University of British Columbia (UBC), Vancouver, British Columbia, Canada

3. Department of Family Medicine, McGill University, Montréal, Québec, Canada

4. Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada

5. Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada

6. Dalla School of Public Health, University of Toronto, Toronto, Ontario, Canada

7. Immunodeficiency Clinic, University Health Network, Toronto, and Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada

8. Oak Tree Clinic, BC Women’s Hospital, Vancouver, British Columbia, Canada

9. Department of Obstetrics and Gynecology, UBC, Vancouver, British Columbia, Canada

10. Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montréal, Québec, Canada

11. Department of Pharmacy, Centre Hospitalier de l’Université de Montréal, Montréal, Québec, Canada

12. Department of Epidemiology, Biostatistics, and Occupational Health, School of Population and Global Health, McGill University, Montréal, Québec, Canada

13. McGill University Health Centre, Montréal, Québec, Canada

Abstract

Background: Women represent one quarter of the population living with HIV in Canada and are an increasingly important sector of the HIV community. While some women’s health issues such as cervical cancer screening and management are well addressed in HIV management guidelines, others are not. These include sexual and reproductive health factors such as contraception, pre-conception planning, and menopause. Existing literature has shown that while women living with HIV in Canada receive good HIV care based on HIV care cascade indicators, their women’s health and sexual and reproductive health care needs are not being met. Methods: In this article, we present a clinical guide for clinicians providing care for women living with HIV on three key women’s health topics that are under-discussed during HIV care visits: (1) contraception, (2) pre-conception planning, and (3) menopause. Results: We have summarized the most pertinent clinical factors on each topic to support straightforward counselling and present important considerations in the context of HIV-related diseases and treatment. Finally, when relevant, we have provided practical stepwise approaches for addressing each of these women’s health care topics when seeing a patient during a visit. Conclusions: It is important that HIV specialists stay well-versed in the complex clinical interactions between HIV treatment and management of women’s health issues.

Publisher

University of Toronto Press Inc. (UTPress)

Subject

Infectious Diseases,Microbiology (medical)

Reference78 articles.

1. HIV in Canada—Surveillance Report, 2018

2. Cohort profile: The Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS)

3. 3. Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and HIV-infected children [Internet]. Washington, DC: US Department of Health and Human Services; 2021 [cited 2021 Jan 29]. https://clinicalinfo.hiv.gov/sites/default/files/inline-files/adult_oi.pdf.

4. 4. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV[Internet]. Washington, DC: US Department of Health and Human Services; 2020 Jun 29 [cited 2021 Jan 29]. http:// clinicalinfo.hiv.gov/sites/default/files/inline-files/ AdultandAdolescentGL.pdf.

5. Assessing Gaps in Comprehensive HIV Care Across Settings of Care for Women Living with HIV in Canada

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