Effectiveness of Hormonal Contraception in HIV-Infected Women using Antiretroviral Therapy: A Prospective Study
Published Date:Nov 2015
Corporate Authors:for the Partners in Prevention HSV/HIV Transmission Study and Partners PrEP Study Teams
Antiretroviral Therapy, Highly Active
Contraceptive Agents, Female
Pubmed Central ID:PMC4748843
Funding:R21 HD074439/HD/NICHD NIH HHS/United States
U48 DP005013/DP/NCCDPHP CDC HHS/United States
U48 DP 005013/DP/NCCDPHP CDC HHS/United States
To assess whether antiretroviral therapy (ART) may diminish the effectiveness of hormonal contraceptive methods.
Using data from 5,153 HIV-infected women followed prospectively one to three years in three HIV prevention studies in Africa, we compared incident pregnancy rates by contraceptive method (implant, injectable, oral, or none) and ART use. Multivariable Cox regression models were used to determine adjusted hazard ratios (aHR) and test interactions between each method and ART use.
During follow-up, 9% of women ever used implants, 40% used injectables, and 14% used oral contraceptives; 31% of women ever used ART, mostly nevirapine (75% of ART users) or efavirenz-based (15%). Among women not using contraception, pregnancy rates were 13.2 and 22.5 per 100 women-years for those on and not on ART, respectively. Implants greatly reduced the incidence of pregnancy among both women on ART (aHR 0.06, 95% CI 0.01-0.45) and not on ART (aHR 0.05, 95% CI 0.02-0.11). Injectables (aHR 0.18 on ART and aHR 0.20 not on ART) and oral contraceptives (aHR 0.37 on ART and aHR 0.36 not on ART) also reduced pregnancy risk, though by lesser degrees. ART use did not significantly diminish contraceptive effectiveness, although all methods showed non-statistically significant reduced effectiveness when concurrently using efavirenz.
Hormonal contraceptive methods are highly effective in reducing pregnancy risk in HIV-infected women, including those concurrently using ART. Studies of potential interactions between ART and contraceptives should evaluate real-world effectiveness of contraceptive methods; in this study, implants were the most effective method to prevent pregnancy, even during ART use.
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