Hormonal contraception and vaginal infections among HIV serodiscordant couples in Lusaka, Zambia

Details

• Alternative Title:
  Obstet Gynecol
• Personal Author:
  HADDAD, Lisa B. ; WALL, Kristin M ; TOTE, Katherine ; KILEMBE, William ; VWAILIKA, Bellington ; SHARKEY, Tyronza ; BRILL, Ilene ; CHOMBA, Elwyn ; TICHACEK, Amanda ; ALLEN, Susan
• Description:
  Objective:
  
  To examine the relationship between hormonal contraception (HC) and vaginal infections with bacterial vaginosis (BV), vaginal candidiasis, or trichomoniasis.
  
  Methods:
  
  HIV serodiscordant couples in Zambia were enrolled in a longitudinal cohort. From 1994 to 2002, both partners were seen quarterly and received physical exams including genital examinations. Separate rates for three outcome infections of interest (BV, vaginal candidiasis, and trichomoniasis) were calculated. Bivariate associations between baseline and time-varying covariates and outcome infections of interest were evaluated via unadjusted Anderson-Gill survival models. Adjusted hazard ratios (aHRs) were generated using multivariable Anderson-Gill survival models including demographic and clinical factors found to be associated with both hormonal contraceptive use and each infection of interest.
  
  Results:
  
  There were 1558 cases of BV, 1529 cases of vaginal candidiasis, and 574 cases of trichomoniasis over 2143.42 person-years of observation. DMPA users had significantly lower rates of trichomoniasis and BV. In adjusted models, DMPA was protective for BV (aHR=0.72; 95% confidence interval (CI) 0.54-0.95), candidiasis (aHR 0.75, 95%CI 0.57-1.00) and trichomoniasis (aHR=0.43, 95%CI 0.25-0.74). Oral contraceptive pills (OCPs) were protective for candidiasis (aHR=0.79, 95%CI 0.65-0.97).
  
  Conclusions:
  
  We confirm that DMPA use was associated with reduced rates of the three most common causes of vaginitis and OCP use was associated with reduced rates of candidiasis among women in HIV-discordant couples. Further research is necessary to understand the factors that may alter the vaginal environment leading to increased HIV risk.
  
  
• Subjects:
  Adult Candidiasis, Vulvovaginal Contraceptives, Oral, Hormonal Female HIV Seronegativity HIV Seropositivity Hormonal Contraception Humans Male Medroxyprogesterone Acetate Sexual Partners Trichomonas Vaginitis Vaginitis Vaginosis, Bacterial

  More +
• Source:
  Obstet Gynecol. 134(3):573-580
• Pubmed ID:
  31403592
• Pubmed Central ID:
  PMC9172972
• Document Type:
  Journal Article
• Funding:
  P30 AI050409/AI/NIAID NIH HHSUnited States/ ; R01 HD040125/HD/NICHD NIH HHSUnited States/ ; R01 AI051231/AI/NIAID NIH HHSUnited States/ ; K01 MH107320/MH/NIMH NIH HHSUnited States/ ; R01 AI023980/AI/NIAID NIH HHSUnited States/ ; R37 AI051231/AI/NIAID NIH HHSUnited States/ ; R01 MH066767/MH/NIMH NIH HHSUnited States/ ; K23 HD078153/HD/NICHD NIH HHSUnited States/ ; U2G PS000758/PS/NCHHSTP CDC HHSUnited States/ ; R01 AI064060/AI/NIAID NIH HHSUnited States/ ; D43 TW001042/TW/FIC NIH HHSUnited States/
• Place as Subject:
  Zambia
• Volume:
  134
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:6027c1cde2adc40c9415bc7204849b02afe274c3e6aeb94ecc421ed63e0fb99a
• Download URL:
  https://stacks.cdc.gov/view/cdc/119244/cdc_119244_DS1.pdf
• File Type:
  [PDF - 99.35 KB ]