Details:

Alternative Title:
Lancet HIV
Personal Author:
PATEL, Rena C. ; ONONO, Maricianah ; GANDHI, Monica ; BLAT, Cinthia ; HAGEY, Jill ; ... More +
PATEL, Rena C. ; ONONO, Maricianah ; GANDHI, Monica ; BLAT, Cinthia ; HAGEY, Jill ; SHADE, Starley B. ; VITTINGHOFF, Eric ; BUKUSI, Elizabeth A. ; NEWMANN, Sara J. ; COHEN, Craig R. ; Less -
Description:
Background Given recent concerns of efavirenz reducing the efficacy of contraceptive implants, we sought to determine if pregnancy rates differ among HIV-positive women using various contraceptive methods and efavirenz- or nevirapine-based antiretroviral therapy (ART) regimens. Methods We conducted a retrospective cohort analysis of HIV-positive women aged 15–45 years enrolled in HIV care facilities in western Kenya from January 2011 to December 2013. Pregnancy was diagnosed clinically and the primary exposure was a combination of contraceptive method and ART regimen. We used Poisson models, adjusting for repeated measures, as well as demographic, behavioral and clinical factors, to compare pregnancy rates among women on different contraceptive/ART combinations. Findings 24,560 women contributed 37,635 years of follow-up with 3,337 incident pregnancies. Among women using implants, adjusted pregnancy incidence for nevirapine- and efavirenz-based ART users were 1·1 (95% CI 0·72–1·5) and 3·3 (95% CI 1·8–4·8) per 100 women-years (w-y), respectively (adjusted incidence rate ratio (aIRR) 3·0, 95% CI 1·3–4·6). Among women using depomedroxyprogesterone acetate (DMPA), adjusted pregnancy incidence for nevirapine- and efavirenz-based ART users were 4·5 (95% CI 3·7–5·2) and 5·4 (95% CI 4·0–6·8) per 100 w-y, respectively (aIRR 1·2, 95% CI 0·91–1·5). Women using other contraceptive methods, except for intrauterine devices and permanent methods, experienced 3·1–4·1 higher rates of pregnancy than women using implants, with 1·6–2·8 higher rates specifically among women using efavirenz-based ART. Interpretation While HIV-positive women using implants on efavirenz-based ART faced three times higher risk of contraceptive failure than those on nevirapine-based ART, these women still experienced lower contraceptive failure rates than women on all other contraceptive methods, except for intrauterine devices and permanent methods. Guidelines for contraceptive and ART combinations should balance the failure rates for each contraceptive method and ART regimen combination against the high effectiveness of implants. Funding Supported by the President’s Emergency Plan for AIDS Relief and the Centers for Disease Control and Prevention.
Subject:
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Adolescent
Adult
Anti-HIV Agents
Article
Benzoxazines
Contraceptive Agents
Drug Therapy, Combination
Female
HIV Infections
Humans
Longitudinal Studies
Nevirapine
Pregnancy
Pregnancy Rate
Retrospective Studies
Treatment Outcome

Source:
Lancet HIV. 2(11):e474-e482.
Pubmed ID:
26520927
Pubmed Central ID:
PMC4632202
Document Type:
Journal Article ;
Funding:
KL2 TR000143/TR/NCATS NIH HHS/United States ; T32AI007641/AI/NIAID NIH HHS/United States ; T32 AI007641/AI/NIAID NIH HHS/United States ; KL2TR000143/TR/NCATS NIH HHS/United States ; PS001913/PS/NCHHSTP CDC HHS/United States ; ... More +
KL2 TR000143/TR/NCATS NIH HHS/United States ; T32AI007641/AI/NIAID NIH HHS/United States ; T32 AI007641/AI/NIAID NIH HHS/United States ; KL2TR000143/TR/NCATS NIH HHS/United States ; PS001913/PS/NCHHSTP CDC HHS/United States ; R01 AI098472/AI/NIAID NIH HHS/United States ; K23 AI120855/AI/NIAID NIH HHS/United States ; PEPFAR/United States ; K23AI120855/AI/NIAID NIH HHS/United States ; Less -
Place as Subject:
Kenya ;
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:a326250775c41a40fc693b4ac5b9f77521fe027af36de5091354ccc0dc51ed74
File Type:

Supporting Files

• 	NIHMS732884-supplement-1.pdf	pdf
  	nihms732884.nxml	bin

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