BC Centre in HIV/AIDS Primary Care Guidelines

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4 Women and Transgender People with HIV

Pregnancy

  • Discuss pregnancy plans with all individuals of childbearing potential upon initiation of HIV care and routinely thereafter. See also 1.1 History, 1.2 Physical Examination

    • Offer preconception counselling to HIV-positive individuals who are contemplating pregnancy

    • Avoid prescribing efavirenz (Sustiva®, Atripla®), or any new under-studied drug, to anyone who wishes to become pregnant

  • Pregnancy in HIV-positive individuals is considered a high risk and complex; therefore, consultation with or referral to an obstetrician experienced in HIV is highly recommended.

  • Antiretroviral (ARV) therapy during and after pregnancy See also 2.2 ARV Therapy

    • Treat all HIV+ pregnant individuals with ARV therapy, regardless of their immunologic or virologic status, to prevent infection of the fetus.
    • Avoid prescribing efavirenz (Sustiva®, Atripla®), or any new under-studied drug, during the first trimester of pregnancy,
    • Do not start nevirapine (Viramune®, Nevirapine XR) during pregnancy. Continue ARV therapy after delivery
  • Breastfeeding is not recommended, regardless of HIV viral load and use of ARV therapy, for HIV-positive individuals in Canada.
  • Contraceptive counseling should be included as a critical aspect of postpartum care.

Contraception

  • Discuss contraception with all individuals of childbearing potential upon initiation of HIV care and routinely thereafter.

  • Avoid prescribing efavirenz (Sustiva®, Atripla®), or any new under-studied drug, to individuals of child-bearing potential who do not use effective and consistent contraception.

  • Consider drug interactions between hormonal contraceptives and ARV agents. See also Drug Interactions Table

  • IUDs can be considered as a safe and effective contraception option for HIV-positive women and adolescents.

  • See also Society of Obstetricians and Gynaecologists of Canada Committee’s guidelines.

Screening for Cervical and Breast Cancers

  • Cervical Pap smear screening should be done for any HIV-positive individual with a cervix starting at age 21 or 3 years after first sexual contact, whichever occurs first.

  • Breast cancer screening for HIV-positive people should follow provincial guidelines for the general population.

    • Consider screening in transgender women on long-term hormone replacement >5 years, and in transgender men and others who may have had mastectomy for non-cancer related reasons.

    • See also 2.3 Monitoring, Screening Mammography Program

Hormone Replacement Therapy (HRT)

  • HRT may be considered in patients who experience severe menopausal symptoms (i.e. vasomotor symptoms and vaginal dryness) but should generally be used only for a limited period of time and at the lowest effective doses.

  • HRT for HIV-positive transgender individuals should be provided in consultation with an endocrinologist or other clinician who has experience providing endocrine care to transgender individuals.

  • Drug interactions between HRT and antiretroviral agents need to be considered. See also Drug Interactions Table

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