HIV and implant contraception — DFSRH MCQ

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HardContraception in special circumstancesHIV and implant contraceptionDFSRH

A 35-year-old woman with well-controlled HIV on antiretroviral therapy asks for an implant. Her viral load is undetectable and she uses dolutegravir/lamivudine. What is the most appropriate management?

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Correct answer: A — Offer the implant and check for drug interactions with her antiretroviral regimen

The best answer is “Offer the implant and check for drug interactions with her antiretroviral regimen”. Most people with well-controlled HIV can use a range of contraception, but antiretroviral interactions should be checked. HIV itself is not a contraindication to implant use in this stable scenario. CHC also needs eligibility and interaction review, copper IUD is not the sole option, and detectable viral load is not a prerequisite for contraception. The pearl is to separate HIV status from specific antiretroviral interactions. Progestogen-only methods have product-specific initiation, missed-pill and interaction rules. Amenorrhoea is a method effect and does not by itself establish menopause, while a new change in bleeding pattern still requires appropriate assessment. Enzyme induction can reduce pill or implant effectiveness, whereas DMPA and intrauterine methods are generally unaffected.

Reference: CoSRH/FSRH, Progestogen-only Implant: https://www.cosrh.org/Common/Uploaded%20files/documents/fsrh-guideline-progestogen-only-implants.pdf