About
The Journal "Obstetrics and Gynecology"Journal HistoryAims and ScopePolicies on Conflict of Interest, Human and Animal Rights, and Informed ConsentEditorial ProcessData sharing statementAdvertising PolicyThe Process for Handling Cases Requiring Corrections, Retractions, and Editorial Expressions of ConcernEditorial BoardEditorial CounsilInformation for ProfessionalsNewsContacts
ArchiveEthical StandardsSubscription
For authors
InstructionsInformed consent policyContract offerEASE GuidelinesICJME CriteriaWAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications
Reviewing
About
The Journal "Obstetrics and Gynecology"Journal HistoryAims and ScopePolicies on Conflict of Interest, Human and Animal Rights, and Informed ConsentEditorial ProcessData sharing statementAdvertising PolicyThe Process for Handling Cases Requiring Corrections, Retractions, and Editorial Expressions of ConcernEditorial BoardEditorial CounsilInformation for ProfessionalsNewsContacts
ArchiveEthical StandardsSubscription
For authors
InstructionsInformed consent policyContract offerEASE GuidelinesICJME CriteriaWAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications
Reviewing
Logout
Obstetrics and Gynegology2023№12
The use of a subcutaneous...

The use of a subcutaneous contraceptive implant in women with chronic viral infections

DOI
https://dx.doi.org/10.18565/aig.2023.295

Samarina A.V., Mozaleva O.L., Martirosian M.M., Skryabneva T.S., Shamaeva N.S., Filatova M.P.

1) Center for the Prevention and Control of AIDS and Infectious Diseases, St. Petersburg, Russia; 2) Pavlov First St. Petersburg State Medical University, Ministry of Health of Russia, St. Petersburg, Russia

The proportion of women with HIV continues to grow due to the prevalence of sexual transmission route of the infection. Most of the patients are reproductive-aged women who are not always interested in pregnancy and need counseling on family planning issues. The frequency of unwanted pregnancies and obstetric complications in HIV-infected patients is higher than frequency in the population, thus the risks of maternal and infant mortality in this group of patients are increased. Unwanted and unplanned pregnancy in women with HIV is a predictor of low commitment to monitoring and receiving prevention of perinatal HIV transmission. The task of a practitioner working with this group of patients is to conduct detailed family planning counseling. During the choice of contraception, it is necessary to assess the safety and effectiveness of the chosen method, taking into account high comorbidity and drug interactions, in particular interaction with antiretroviral therapy (ART). There was a study of 41 women with HIV who used a contraceptive radiopaque implant containing 68 mg of etonogestrel (ETG). The study was conducted at the Center for the Prevention and Control of AIDS and Infectious Diseases, St. Peterburg. When the patients used the implant with ETG, there were no significant changes in the number of CD4 lymphocytes, hemoglobin levels, ALT and AST, body weight, as well as serious adverse events; these findings confirm the safety of using this contraception method in HIV-infected women and patients with HIV coinfection and chronic hepatitis C (HCV). There was a decrease in the average level of HIV RNA in dynamics which could be connected with an increase in patients receiving ART; their percentage increased from 85% to 100% during the study period.
Conclusion: Before administering hormonal contraception or starting ART/changing the ART regimen in patients with HIV, it is necessary to evaluate possible drug interactions. It is important to integrate family planning services in the treatment of women with chronic viral infections and provide them with contraceptives via regional HIV prevention programs.

Authors’ contributions: Samarina A.V., Mosaleva O.L., Martirosian M.M., Shamaeva N.S., Skryabneva T.S. – collecting and processing of the material, Samarina A.V., Filatova M.P. – writing the text.
Conflicts of interest: Authors declare lack of the possible conflicts of interests.
Funding: The study was conducted without sponsorship.
Ethical Approval: The study was approved by the Ethical Review Board of the Center for the Prevention and Control of AIDS and Infectious Diseases, St. Petersburg.
Patient Consent for Publication: The patients provided an informed consent for the publication of their data.
For citation: Samarina A.V., Mozaleva O.L., Martirosian M.M., Skryabneva T.S., Shamaeva N.S., Filatova M.P. The use of a subcutaneous contraceptive implant in women with chronic viral infections.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; (12): 169-179 (in Russian)
https://dx.doi.org/10.18565/aig.2023.295

Keywords

HIV and hormonal contraception
etonogestrel implant in women with HIV
chronic viral infections and contraception
family planning and HIV infection
Implanon NKST contraceptive
Full text (in Russian)

References

  1. Calvert C., Ronsmans C. HIV and the risk of direct obstetric complications: a systematic review and meta-analysis. PLoS One. 2013; 8(10): e74848.https://dx.doi.org/10.1371/journal.pone.0074848.
  2. Reitter A., Stücker A.U., Linde R., Königs C., Knecht G., Herrmann E. et al. Pregnancy complications in HIV-positive women: 11-year data from the Frankfurt HIV Cohort. HIV Med. 2014; 15(9): 525-36. https://dx.doi.org/10.1111/hiv.12142.
  3. Ладная Н.Н., Соколова Е.В., Покровский В.В. Основные тенденции развития эпидемии ВИЧ-инфекции среди женщин в Российской Федерации в 2021 году. В кн.: Сборник трудов Международной научно-практической конференции «Актуальные вопросы ВИЧ-инфекции. Охрана здоровья матери и ребенка», Санкт-Петербург; 2022: 5-13. [Ladnaya N.N., Sokolova E.V., Pokrovsky V.V. The main trends in the development of the HIV epidemic among women in the Russian Federation in 2021. In: Collection of works of International scientific and practical conference "Topical issues of HIV infection. Maternal and child health protection", Saint Petersburg; 2022: 5-13. (in Russian)].
  4. Lathrop E., Jamieson D.J., Danel I. HIV and maternal mortality. Int. J. Gynaecol. Obstet. 2014; 127(2): 213-5. https://dx.doi.org/10.1016/j.ijgo.2014.05.024.
  5. Мозалева О.Л., Самарина А.В. Материнская смертность среди ВИЧ-инфицированных женщин в Санкт-Петербурге. В кн.: Сборник трудов Международной научно-практической конференции «Актуальные вопросы ВИЧ-инфекции. Охрана здоровья матери и ребенка», Санкт-Петербург; 2022: 152. [Mozaleva O.L., Samarina A.V. Maternal mortality among HIV-infected women in St. Petersburg. Collection of works of International scientific and practical conference "Topical issues of HIV infection. Maternal and child health protection, "Saint Petersburg; 2022: 152(in Russian)].
  6. Сухих Г.Т., Прилепская В.Н., ред. Национальные медицинские критерии приемлемости методов контрацепции. Адаптированный документ «Медицинские критерии приемлемости использования методов контрацепции ВОЗ, 5 издание, 2015». М.; 2023. [Sukhikh G.T., Prilepskaya V.N., ed. National medical criteria for the acceptability of contraception methods. Adapted document "WHO Medical eligibility criteria for contraceptive use, 5th edition, 2015". Moscow; 2023.(in Russian)].
  7. World Health Organization. Medical eligibility criteria for contraceptive use. Fifth edition; 2015. https://www.who.int/publications/i/item/9789241549158
  8. Мозалева О.Л., Самарина А.В. Социально-демографические и эпидемиологические характеристики ВИЧ-инфицированных беременных женщин в Санкт-Петербурге как фактор риска перинатальной передачи ВИЧ. ВИЧ-инфекция и иммуносупрессии. 2019; 11(3): 7-15. [Mozaleva O.L., Samarina A.V. Demographic and epidemiological characteristics of the HIV-infected pregnant women in Saint-Petersburg. HIV Infection and Immunosuppressive Disorders. 2019; 11(3): 7-15. (in Russian)].https://dx.doi.org/10.22328/2077-9828-2019-11-3-7-15.
  9. Whiteman M.K., Jeng G., Samarina A., Akatova N., Martirosyan M., Kissin D.M. et al. Associations of hormonal contraceptive use with measures of HIV disease progression and antiretroviral therapy effectiveness. Contraception. 2016; 93(1): 17-24. https://dx.doi.org/10.1016/j.contraception.2015.07.003.
  10. Global AIDS Strategy 2021-2026. End Inequalities. End AIDS. Geneva; 2021. 100p. https://www.unaids.org/en/Global-AIDS-Strategy-2021-2026
  11. Wilcher R., Hoke T., Adamchak S.E., Cates W. Jr. Integration of family planning into HIV services: a synthesis of recent evidence. AIDS. 2013; 27 Suppl 1: S65-75. https://dx.doi.org/10.1097/QAD.0000000000000051.
  12. Lopez L.M., Hilgenberg D., Chen M., Denison J., Stuart G. Behavioral interventions for improving contraceptive use among women living with HIV. Cochrane Database Syst. Rev. 2013; (1): CD010243.https://dx.doi.org/10.1002/14651858.CD010243.pub2.
  13. Министерство здравоохранения Российской Федерации. Клинические рекомендации «ВИЧ-инфекция у беременных». 2021. 93 с. [Ministry of Health of the Russian Federation. Clinical guidelines "HIV infection in pregnant women". 2021. 93 p. (in Russian)].
  14. Loutfy M., Johnson M., Walmsley S., Samarina A., Vasquez P., Hao-Lan H. et al. The association between HIV disclosure status and perceived barriers to care faced by women living with HIV in Latin America, China, Central/Eastern Europe, and Western Europe/Canada. AIDS Patient Care STDS. 2016; 30(9): 435-44. https://dx.doi.org/10.1089/apc.2016.0049.
  15. Johnson M., Samarina A., Xi H., Valdez Ramalho Madruga J., Hocqueloux L., Loutfy M. et al. Barriers to access to care reported by women living with HIV across 27 countries. AIDS Care. 2015; 27(10): 1220-30. https://dx.doi.org/10.1080/09540121.2015.1046416.
  16. Morrison C.S., Hofmeyr G.J., Thomas K.K., Rees H., Philip N., Palanee-Phillips T. et al.; ECHO Trial Team. Effects of depot medroxyprogesterone acetate, copper intrauterine devices, and levonorgestrel implants on early HIV disease progression. AIDS Res. Hum. Retroviruses. 2020; 36(8): 632-40.https://dx.doi.org/10.1089/AID.2020.0015.
  17. Whiteman M.K., Kissin D.M., Samarina A., Curtis K.M., Akatova N., Marchbanks P.A. et al. Determinants of contraceptive choice among women with HIV. AIDS. 2009; 23 Suppl 1: S47-54. https://dx.doi.org/10.1097/01.aids.0000363777.76129.b4.
  18. Chappell C.A., Harkoo I., Szydlo D.W., Bunge K.E., Singh D., Nakabiito C. et al.; CAT and MTN-020/ASPIRE Study Team. Contraceptive method switching among women living in sub-Saharan Africa participating in an HIV-1 prevention trial: a prospective cohort study. Contraception. 2019; 100(3): 214-8.https://dx.doi.org/10.1016/j.contraception.2019.06.006.
  19. Todd C.S., Anderman T.C., Long S., Myer L., Bekker L.G., Petro G.A., Jones H.E. A systematic review of contraceptive continuation among women living with HIV. Contraception. 2018; 98(1): 8-24. https://dx.doi.org/10.1016/j.contraception.2018.02.002.
  20. Лещенко О.Я., Генич Е.В. Клинические особенности нарушений репродуктивного здоровья и полового поведения женщин с ВИЧ-инфекцией. ВИЧ-инфекция и иммуносупрессии. 2022; 14(2): 31-9. [Leschenko О.Ya.,Genich Е.V. Сlinical features of disorders of reproductive health and sexual behavior in women with HIV. HIV Infection and Immunosuppressive Disorders. 2022; 14(2): 31-9. (in Russian)]. https://dx.doi.org/10.22328/2077-9828-2022-14-2-31-39.
  21. Akatova N. Integration of family planning services for HIV-infected women. In: Akatova N., Belyakov N., Samarina A., Stepanova E., Rakhmanova A., Volkova G., Martirosyan M., Yakovlev A., Revzina N., Kissin D., Hillis S. AIDS 2010 – ХVIII International AIDS Conference, Vienna, 18–23 July 2010. Abstract THPDD204.
  22. Акатова Н.Ю. Интеграция программы планирования семьи в систему оказания помощи ВИЧ-инфицированным женщинам. Материалы научно-практической конференции «ВИЧ-инфекция и иммуносупрессии» (20 лет Санкт-Петербургскому Центру по профилактике и борьбе со СПИД и инфекционными заболеваниями – II Виноградовские чтения), 21–22 октября 2010 г., Санкт-Петербург, Россия. ВИЧ-инфекция и иммуносупрессии. 2010; 2(4): 99-100. [Akatova N.Yu. Integration of the family planning program into the system of care for HIV-infected women. Materials of the scientific and practical conference "HIV infection and immunosuppression" (20 years old St. Petersburg Center for the Prevention and Control of AIDS and Infectious Diseases - II Vinogradov Readings), October 21-22, 2010, St. Petersburg, Russia. HIV infection and immunosuppression. 2010; 2(4): 99-100. (in Russian)].
  23. Samarina A.V. Access to modern contraception among HIV-infected women receiving clinical care. In: Akatova N., Belyakov N., Samarina A., Stepanova E., Rakhmanova A., Volkova G., Martirosyan M., Yakovlev A., Revzina N., Kissin D., Hillis S. AIDS 2010 – ХVIII International AIDS Conference, Vienna, 18–23 July 2010. Abstract THPE0640.
  24. European AIDS Clinical Society (EACS). EACS 12.0 guidelines; 2023: 38-39. https://www.eacsociety.org/guidelines/eacs-guidelines/
  25. Халезова Н.Б., Боева Е.В., Рассохин В.В., Стасишкис Т.А., Ковеленов А.Ю., Студилко Е.В., Беляков Н.А. Женщины с коинфекцией ВИЧ и вирусный гепатит С. Часть 1. Психосоциальная характеристика и готовность к противовирусной терапии. ВИЧ-инфекция и иммуносупрессии. 2018;10(3): 30-9. [Khalezova N.В., Boyeva Е.V., Rassokhin В.В., Stasishkis T.A., Kovelenov A.Yu., Studilko E.V., Belyakov N.A. Women co-infected with HIV and VHC. Part 1. Psychosocial characteristic and readiness to antiviral therapy. HIV Infection and Immunosuppressive Disorders. 2018; 10(3): 30-9.(in Russian)]. https://dx.doi.org/10.22328/2077-9828-2018-10-3-30-39.
  26. Самарина А.В., Мозалева О.Л. Сравнительный анализ социально-эпидемиологических и клинико-лабораторных показателей ВИЧ-инфицированных беременных с выраженным иммунодефицитом и нормальным иммунным статусом. В кн.: V конференция с международным участием «Перинатальная медицина: от предгравидарной подготовки к здоровому материнству и детству»: сборник тезисов. 2019: 69-70. [Samarina A.V., Mozaleva O.L. Comparative analysis of socio-epidemiological and clinical-laboratory indicators of HIV-infected pregnant women with severe immunodeficiency and normal immune status. In: V conference with international participation "Perinatal medicine: from pre-gravidary preparation for healthy motherhood and childhood": a collection of theses. 2019: 69-70.(in Russian)].
  27. Гусев Д.А., Самарина А.В., Ястребова Е.Б., Мозалева О.Л. Современные аспекты профилактики перинатальной передачи ВИЧ в Санкт-Петербурге. Журнал инфектологии. 2019; 11(1): 58-64. [Gusev D.A., Samarina A.V., Yastrebova E.B., Mozaleva O.I. Current state of prevention of mother-to-child HIV transmission in Saint-Petersburg. Journal Infectology. 2019; 11(1): 58-64. (in Russian)]. https://dx.doi.org/10.22625/2072-6732-2019-11-1-58-64.
  28. Мозалева О.Л., Самарина А.В. Влияние выраженного иммунодефицита у ВИЧ-инфицированных беременных на течение беременности, частоту преждевременных родов и перинатальную передачу ВИЧ. В кн.: Материалы Международной научно-практической конференция «Актуальные вопросы ВИЧ-инфекции»; 2019: 305-7. [Mozaleva OL, Samarina A.V. Effect of severe immunodeficiency in HIV-infected pregnant women on the course of pregnancy, frequency of preterm birth and perinatal transmission of HIV. In: Materials of the International Scientific and Practical Conference "Topical Issues of HIV Infection"; 2019: 305-7.(in Russian)].
  29. Горыня Л.А., Мазуров В.И., Мусатов В.Б. Анемия у ВИЧ-инфицированных пациентов. Патогенез и современная терапевтическая тактика. Вестник Санкт-Петербургского университета. Серия 11: Медицина. 2014; 2: 54-65. [Gorynya L.A., Mazurov V.I., Musatov V.B. Anemia in patients with HIV and AIDS. Pathogenesis and modern therapeutic strategy. Bulletin of St. Petersburg University. Series 11: Medicine. 2014; 2: 54-65 (in Russian)].
  30. Мозалева О.Л., Самарина А.В., Рассохин В.В. Анемии и тромбоцитопении у ВИЧ-инфицированных беременных. Журнал акушерства и женских болезней. 2022; 71(2): 69-78. [Mozaleva O.L., Samarina A.V., Rassokhin V.V. Anemia and thrombocytopenia in HIV-positive pregnant women. Journal of obstetrics and women's diseases. 2022; 71(2): 69-78. (in Russian)].https://dx.doi.org/10.17816/JOWD98476.
  31. Кругова Л.В., Вартанов В.Я., Хуторская Н.Н., Лаптева И.В., Шифман Е.М. Коррекция анемии у ВИЧ-инфицированных беременных, получающих антиретровирусные препараты. Анестезиология и реаниматология. 2012; 6: 17-21. [Krugova L.V., Vartanov V.YA., Hutorskaya N.N., Lapteva I.V., Shifman E.M. Anaemia correction in HIV-positive pregnant women receiving antiretroviral therapy. Russian Journal of Anesthesiology and Reanimatology. 2012; 6: 17-21 (in Russian)].
  32. Костерина А.В. Диагностика и лечение анемического и тромбоцитопенического синдромов у беременных. Практическая медицина. 2017; 8(109): 81-4. [Коsterina А.V. Some issues of diagnostics and treatment of anemia and thrombocytopenia in pregnancy. Practical medicine. 2017; 8(109): 81-4(in Russian)].
  33. Вартанов В.Я., Кругова Л.В., Шифман Е.М. Нарушения гемостаза у ВИЧ-инфицированных беременных на фоне химиопрофилактики антиретровирусными препаратами и пути их коррекции. Анестезиология и реаниматология. 2012; 6: 13-7. [Vartanov V.Ya., Krugova L.V., Shifman E.M. Haemostasis disturbances and ways of its correction in HIV-positive pregnant women receiving antiretroviral therapy. Russian Journal of Anesthesiology and Reanimatology. 2012; 6: 13-7 (in Russian)].
  34. Хабаров С.В. Коррекция железодефицитного состояния у женщин в период беременности. Акушерство и гинекология. 2023; 6: 115-22. [Khabarov S.V. Correction of an iron-deficiency state in women during pregnancy. Obstetrics and Gynecology. 2023; (6): 115-22 (in Russian)].https://dx.doi.org/10.18565/aig.2023.146.
  35. Сафонова П.В., Рассохин В.В., Диклементе Р.Д., Браун Д.Л., Сейлс Д., Роуз И.С., Рыбников В.Ю., Виноградова Т.Н., Беляков Н.А. Опыт употребления психоактивных веществ в прошлом и рискованное поведение в настоящем у ВИЧ-инфицированных женщин. ВИЧ-инфекция и иммуносупрессии. 2014; 6(4): 24-34. [Safonova P.V., Rassokhin V.V., Diclemente R.., Brown J.L., Sales J.M., Rose E.S., Rybnikov V.Yu., Vinogradova T.N., Belyakov N.A. Influence of substance use history on risky behavior in the present in HIV-infected women receiving HAART. HIV Infection and Immunosuppressive Disorders. 2014; 6(4): 24-34. (in Russian)]. https://dx.doi.org/10.22328/2077-9828-2014-6-4-24-34.
  36. Blumenthal P.D., Gemzell-Danielsson K., Marintcheva-Petrova M. Tolerability and clinical safety of Implanon. Eur. J. Contracept. Reprod. Health Care. 2008; 13 Suppl 1: 29-36. https://dx.doi.org/10.1080/13625180801960012.
  37. Mansour D., Korver T., Marintcheva-Petrova M., Fraser I.S. The effects of Implanon on menstrual bleeding patterns. Eur. J. Contracept. Reprod. Health Care. 2008; 13 Suppl 1: 13-28. https://dx.doi.org/10.1080/13625180801959931.

Received 14.12.2023

Accepted 21.12.2023

About the Authors

Anna V. Samarina, Dr. Med. Sci., Head of the Department of Motherhood and Childhood, Center for the Prevention and Control of AIDs and Infectious Diseases, Saint Petersburg, Russia; Professor of the Department of Socially Significant Infections and Phthisiopulmonology, Academician I.P. Pavlov First St. Petersburg State Medical University, Ministry of Health of Russia, +7(921)931-72-57, avsamarina@mail.ru, https://orcid.org/0000-0003-1438-2399, SPIN-код: 2878-7130,
179 lit. A and B Naberezhnaya Obvodnogo Kanala, Saint Petersburg, 190103, Russia.
Olga L. Mozaleva, PhD, Department of Motherhood and Childhood, Center for the Prevention and Control of AIDs and Infectious Diseases, Saint Petersburg, Russia, mozaleva.o@yandex.ru, https://orcid.org/0000-0003-4682-9394, 179 lit. A and B Naberezhnaya Obvodnogo Kanala, Saint Petersburg, 190103, Russia.
Margarita M. Martirosian, PhD, Department of Motherhood and Childhood, Center for the Prevention and Control of AIDs and Infectious Diseases, Saint Petersburg, Russia, martirosianmm@mail.ru, 179 lit. A and B Naberezhnaya Obvodnogo Kanala, Saint Petersburg, 190103, Russia.
Tatiana S. Skryabneva, MD, Department of Motherhood and Childhood, Center for the Prevention and Control of AIDs and Infectious Diseases, Saint Petersburg, Russia, skryabneva.tanya@mail.ru, 179 lit. A and B Naberezhnaya Obvodnogo Kanala, Saint Petersburg, 190103, Russia.
Natalia S. Shamaeva, MD, Department of Motherhood and Childhood, Center for the Prevention and Control of AIDs and Infectious Diseases, Saint Petersburg, Russia, nataljklokova@mail.ru, 179 lit. A and B Naberezhnaya Obvodnogo Kanala, Saint Petersburg, 190103, Russia.
Marina P. Filatova, MD, Department of Motherhood and Childhood, Center for the Prevention and Control of AIDs and Infectious Diseases, Saint Petersburg, Russia, marinafilatova1964@mail.ru, 179 lit. A and B Naberezhnaya Obvodnogo Kanala, Saint Petersburg, 190103, Russia.
Corresponding author: Anna V. Samarina, avsamarina@mail.ru
By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.