Associations of hormonal contraceptive use with measures of HIV disease progression and antiretroviral therapy effectiveness☆

Details

• Alternative Title:
  Contraception
• Personal Author:
  Whiteman, Maura K. ; Jeng, Gary ; Samarina, Anna ; Akatova, Natalia ; Martirosyan, Margarita ; Kissin, Dmitry M. ; Curtis, Kathryn M. ; Marchbanks, Polly A. ; Hillis, Susan D. ; Mandel, Michele G. ; Jamieson, Denise J.
  More +
• Description:
  Objective ; To examine the associations between hormonal contraceptive use and measures of HIV disease progression and antiretroviral treatment (ART) effectiveness. ; Study design ; A prospective cohort study of women with prevalent HIV infection in St. Petersburg, Russia, was conducted. After contraceptive counseling, participants chose to use combined oral contraceptives (COCs), depot-medroxyprogesterone acetate (DMPA), a copper intrauterine device (IUD) or male condoms for pregnancy prevention. Among participants not using ART at enrollment, we used multivariate Cox regression to assess the association between current (time-varying) contraceptive use and disease progression, measured by the primary composite outcome of CD4 decline to <350 cells/mm3, ART initiation or death. Among participants using ART at enrollment, we used linear mixed models to estimate the predicted mean CD4 change at select time points by contraceptive method. ; Results ; During a total of 5233 months follow-up among participants not using ART with enrollment CD4 ≥ 350 cells/mm3 (n=315), 97 experienced disease progression. Neither current use of COCs adjusted hazard ratio (aHR) 0.91, 95% confidence interval (CI) 0.56–1.48 nor DMPA (aHR 1.28, 95% CI 0.71–2.31) was associated with a statistically significant increased risk for disease progression compared with use of nonhormonal methods (IUD or condoms). Among participants using ART at enrollment (n=77), we found no statistically significant differences in the predicted mean changes in CD4 cell count comparing current use of COCs (p=.1) or DMPA (p=.3) with nonhormonal methods. ; Conclusion ; Hormonal contraceptive use was not significantly associated with measures of HIV disease progression or ART effectiveness among women with prevalent HIV infection. ; Implications ; Hormonal contraceptive use was not significantly associated with measures of HIV disease progression or ART effectiveness among women with prevalent HIV infection.
• Keywords:
  • Antiretroviral agents/therapeutic use
  • CD4 lymphocyte count
  • Contraceptive agents
  • Female/administration and dosage/adverse effects
  • HIV seropositivity/complications/drug therapy/mortality
  • Adolescent
  • Adult
  • Anti-Retroviral Agents
  • CD4 Lymphocyte Count
  • Condoms
  More +
• Source:
  Contraception. 93(1):17-24
• Pubmed ID:
  26197261
• Pubmed Central ID:
  PMC4688178
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHSUnited States/
• Volume:
  93
• Issue:
  1
• Download URL:
  https://stacks.cdc.gov/view/cdc/37018/cdc_37018_DS1.pdf
• File Type:
  [PDF - 483.64 KB]
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:eb0051b519ca117e00714c5285aae3bcc4aa0f9c7aac66d9dc121e1ca07c14c2