Febrasgo apresenta orientações de contracepção para mulheres com HIV
Diante do aumento de 30% na taxa de detecção de HIV em gestantes (1), no Brasil, nos últimos dez anos, (a incidência variou de 2,1 casos/mil nascidos vivos, em 2010, para 2,7 casos/mil nascidos vivos, em 2020), a Federação das Associações de Ginecologia e Obstetrícia (Febrasgo) apresenta orientações de contracepção para mulheres com HIV (vírus da imunodeficiência humana) que não desejem gestar. Fatores como condições de saúde e terapia antirretroviral ministrada podem influenciar na indicação médica de diferentes métodos anticoncepcionais. Segundo o Ministério da Saúde, em gestações planejadas, com os devidos cuidados no pré-natal, parto e amamentação, a taxa de transmissão vertical mostra-se inferior a 2%. Em casos de ausência de acompanhamento correto, o índice pode chegar a 45% (2). De acordo com o órgão, 31,8% das gestantes detectadas com o vírus ainda não haviam iniciado terapia antirretroviral (3).
Atualmente, no Brasil, 920 mil pessoas vivem com HIV. Dentre elas, 65% apresentam-se em idade fértil (18 e 44 anos).
“Neste grupo, o uso da dupla proteção com o condom faz parte das estratégias globais de saúde pública para redução da transmissão vertical (materno fetal) e horizontal do vírus (parceiros sexuais sorodiscordantes)”, explica.
Segundo a médica, métodos de barreira como, capuz cervical e diafragma, não são recomendados para estas mulheres pela falta de proteção na transmissão do vírus HIV aos seus parceiros. Os espermicidas sem o uso do condom, inclusive, não são recomendados porque podem aumentar a chance desta transmissão.
Atualmente, a Organização Mundial de Saúde (OMS) prevê o início de terapia antirretroviral (TARV) quando as pessoas testam positivo para HIV, independentemente da contagem de CD4 (células de defesa) positivo. As mulheres com HIV e que fazem uso de TARV, de modo geral, podem utilizar todos os métodos contraceptivos hormonais. DIUs de LNG ou cobre (com ou sem prata) também podem ser utilizados, desde que estas mulheres em uso de TARV estejam com a doença controlada.
Orientação de Acordo com Características de Saúde
Orientação de Acordo com o Tipo de Terapia Antirretroviral
A Dra. Ilza Monteiro aponta que as mulheres que fazem uso de Inibidores nucleosídeos da transcriptase reversa (NRTIs), Inibidores não nucleosídeos da transcriptase reversa (NNRTIs) mais novos contendo etravirina e rilpivirina e Inibidores da Integrase (II) podem usar sem restrições todos os métodos contraceptivos hormonais.Aquelas que utilizam NNRTIs contendo efavirenz ou nevirapina ou Inibidores da protease (IP) contendo ritonavir, podem usar sem restrição o contraceptivo injetável de progestagênio AMPd e NET-EM. Geralmente, podem utilizar contraceptivos orais combinados, contraceptivos injetáveis combinados, adesivos e anéis contraceptivos combinados, pílulas só com progestagênios, e implantes de LNG e ETG.
“Dados clínicos e farmacocinéticos recentes levantaram preocupações sobre taxas de falha mais altas com o uso concomitante dos implantes e efavirenz. No entanto, essa combinação ainda é recomendada pela OMS para mulheres vivendo com HIV. Assim dentre os métodos reversíveis, os implantes e os DIUs são as formas mais eficazes de contracepção, comparáveis aos métodos cirúrgicos”, pondera a Dra Ilza.
A médica salienta ainda que o vínculo com os serviços de atendimento ao HIV, planejamento familiar e saúde comportamental pode aumentar a proporção de pessoas vivendo com HIV com vírus suprimido, reduzir gestações indesejadas e maximizar a saúde comportamental a longo prazo. A educação é um componente integrante do processo de aconselhamento contraceptivo e ajuda os clientes a tomar decisões informadas e a obter as informações necessárias para usar os métodos contraceptivos corretamente.
* Manifestação clínica das pacientes infectadas pelo HIV, segundo a OMS:
Estágio 2: Inclui pequenas manifestações mucocutâneas e recorrentes infecções do trato respiratório superior
Estágio 3: Inclui diarreia crônica inexplicada por mais de um mês, as infecções bacterianas e a tuberculose pulmonar comprovados geralmente se sobrepõem
Estágio 4: A toxoplasmose cerebral, candidíase do esôfago, traqueia, brônquios e pulmões e o sarcoma de Kaposi; essas doenças são indicadores da AIDS
2. Dados disponibilizados no Boletim Epidemiológico, volume 52, nº 13, abril de 2021.
3. Dados disponibilizados no Boletim Epidemiológico, volume 51, nº 21, maio de 2020.
4. Em meio aos métodos anticoncepcionais de alta eficácia, figuram os contraceptivos:Orais combinados; Injetáveis mensais; Adesivos; Anéis vaginais; Pílulas só com progestagênios; Injetáveis de progestagênios; Implantes (DIU-LNG); Dispositivos intrauterinos com cobre (DIU-Cu). Há ainda os métodos definitivos, como a vasectomia e laqueadura tubária, indicados principalmente para mulheres que possuem filhos e não desejam engravidar novamente.
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است.
افسردگی تنها یک یا دو علامت ساده نیست، بلکه ترکیبی از افکار، احساسات، رفتار ها و تجربیات مختلف است.
افسردگی دارای طیف متنوعی از علائم شامل کاهش
انرژی و بی حوصلگی، لذت نبردن از فعالیت های گذشته،
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گاهی اوقات، در افسردگی علایم جسمانی مانند حالت تهوع
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باشيم.
پرسشي وجود دارد که در تمام طول عمر ذهن انسان را
به خود مشغول ميکند، چگونه شاد باشيم ؟
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اولین رابطه جنسی تجربه ای منحصر به
فرد است. درک این که دقیقاً چه چیزی را باید انتظار داشت، می تواند کمی سخت باشد.
چه احساسی خواهید داشت، چه زمانی باید
این کار را انجام دهید و چگونه می توانید در اولین نزدیکی جنسی ایمن بمانید؟
صرف نظر از اینکه با افراد همجنس
یا جنس مخالف رابطه جنسی داشته باشید، واژههای «باکرگی» و «رابطه جنسی» برای افراد مختلف معانی متفاوتی دارند.
فرقی نمیکند که از کدام تعریف استفاده شود،
خیلی از افراد از داشتن رابطه جنسی
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این نگرانی کاملاً طبیعی است، اما شایعات و داستان هایی که در
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در این مقاله، ما به آنچه ممکن است پس از از دست
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