by Haneefa T Saleem, Manjula Narasimhan, Bela Ganatra, Caitlin E Kennedy
Cochrane Database of Systematic Reviews Issue 12:19 December 2018. No.: CD012834
WHO guidelines on safe abortion methods do not include specific clinical considerations for women living with HIV. Concerns have been raised that women living with HIV may be at greater risk of adverse abortion outcomes compared to HIV‐uninfected women due to immunosuppression, high rates of co‐infection with other sexually transmitted infections, and possible contraindications because of antiretroviral therapy. This systematic review assessed the effectiveness and safety of medical versus surgical abortion among women living with HIV reported in studies up to 17 April 2018 based on all published and unpublished trials and observational studies of medical and surgical abortion among women living with HIV in seven databases, in abstracts on conference websites and unpublished data. It considered randomized and non-randomized controlled trials and observational studies covering effectiveness and safety and outcomes of abortion for medical and surgical methods between women with HIV and women without HIV, and outcomes of abortion among women living with HIV. Of 3840 records screened, only one conference abstract met the inclusion criteria. It assessed the efficacy and acceptability of home administration of misoprostol for early medical abortion among women living with HIV at <63 days amenorrhoea in Ukraine. Medical abortion was effective in 65 of 68 cases. The failures were incomplete abortion (n=1), heavy bleeding (n=1), and ongoing pregnancy (n=1). There were no serious infections. Due to the lack of studies, they were unable to determine if outcome differences exist between women living with HIV and women without HIV. They found no evidence suggesting that medical or surgical abortions are unsafe for women living with HIV. Healthcare providers should not be deterred from providing access to safe abortion to anyone living with HIV.
Editor’s note: Perhaps, considering the lack of evidence over more than 20 years, there is not a problem.