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Hormonal contraception and vaginal infections among HIV serodiscordant couples in Lusaka, Zambia
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9 2019
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Source: Obstet Gynecol. 134(3):573-580
Details:
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Alternative Title:Obstet Gynecol
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Personal Author:
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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.
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Pubmed ID:31403592
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Pubmed Central ID:PMC9172972
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