BOSTON — Providing primary care for women with HIV involves encouraging strict adherence to antiviral treatment and constant monitoring for harmful drug interactions, according to presenters at the American Academy of Physicians Assistants IMPACT 2014 meeting.
Women with HIV have the same pregnancy goals as other women, Deborah M. Smith, MD, MPH, managing director of Blue Cross Blue Shield in Washington, D.C., and Susan LeLacheur, PA-C, associate professor of PA studies at the George Washington School of Medicine and Health emphasized in a session here.
Primary-care practitioners should carefully monitor the interaction between birth control and HIV medications when prescribing a contraceptive regimen to women with HIV. Interactions between protease inhibitors (including ritonavir-boosted atazanavir) or non-nucleoside reverse transcriptase inhibitors (NNRTIs) and contraceptives may lower or raise hormone levels, reducing the efficacy of oral contraceptives.
To assure adequate protection clinicians should prescribe an oral contraceptive containing at least 35 mg of ethinyl estradiol. Other options include injectable depot medroxyprogesterone acetate, which does not interact with NNRTIs, and intrauterine devices, including those that release levonorgestrel.
In addition to assuring contraceptives don’t interfere with HIV medications clinicians should:
- Monitor all drug interactions. Some HIV positive patients stop taking HIV treatments in fear of harming the fetus. Practitioners should encourage consistent treatment adherence
- Consult with a high-risk obstetrician, especially if there are additional risk factors (age, substance abuse, obesity)
- Prescribe nevirapine as an alternative other NNRTIs for women with a CD4 count <250
Preexposure prophylaxis with highly active antiretroviral therapy is recommended for HIV concordant couples attempting to conceive.
Women with HIV are also at greater risk for contracting human papillomavirus due to compromised immune function. Although there are no official recommendations to screen patients with HIV for HPV, the presenters suggested conducting a cervical cytology every six months for patients newly diagnosed with HIV and regular visual examination of the vulva, vagina and perianal areas. After one year of negative test results, cytology should be performed once per year. Tobacco users should be encouraged to quit smoking.