Increasing body mass index or weight does not appear to influence the association between efavirenz-based antiretroviral therapy and implant effectiveness among HIV-positive women in western Kenya

Details

• Alternative Title:
  Contraception
• Personal Author:
  Patel, Rena C. ; Jakait, Beatrice ; Thomas, Katherine ; Yiannoutsos, Constantin ; Onono, Maricianah ; Bukusi, Elizabeth A. ; Wools-Kaloustian, Kara K. ; Cohen, Craig R.
• Description:
  Objective
  
  Our objective was to evaluate if increasing body mass index (BMI) or weight influences the association between efavirenz-based antiretroviral therapy (ART) and implant effectiveness.
  
  Study design
  
  We conducted a secondary cohort analysis of HIV-positive women aged 15 to 45 years enrolled in HIV care in western Kenya using an implant from January 2011 to December 2015. Implant use, ART regimen, and weight were documented at each clinic visit and height at enrollment. We categorized BMI as underweight, normal weight, overweight, or obese, and weight as <70kg or ≥70kg. Our primary outcome was incident pregnancy diagnosed clinically. We used crude and adjusted Poisson models with robust standard errors to account for covariates and repeated observations to estimate adjusted incident rate ratios (aIRR).
  
  Results
  
  In this analysis, 12,960 women contributed a total of 11,285 woman-years (w-y) of observation time while using an implant, with a median of 6.6 months. The aIRRs comparing efavirenz- to nevirapine-based ART groups did not increase as BMI increased; the aIRRs were 2.0 (1.1–3.6) for underweight, 1.9 (1.5–2.5) for normal, 3.1 (1.6–6.0) for overweight, and 2.1 (0.6–6.9) for obese women. The aIRRs comparing efavirenz- to nevirapine-based ART groups did not increase as weight increased; the aIRRs were 2.0 (1.6–2.6) for weight <70kg and 2.1 (1.0–4.5) for weight ≥70kg.
  
  Conclusion
  
  Higher BMI or weight did not appear to modify the relationship between efavirenz use and implant effectiveness.
  
  Implications
  
  Programs should not recommend differential counseling for women with higher BMI or weight who concomitantly use implants and efavirenz.
  
  
• Subjects:
  Adolescent Adult Anti-HIV Agents Benzoxazines Body Mass Index Body Weight Cohort Studies Contraceptive Agents Drug Therapy, Combination Female HIV Infections Humans Male Middle Aged Nevirapine Obesity Overweight Pregnancy Pregnancy Rate Treatment Outcome Young Adult

  More +
• Source:
  Contraception. 100(4):288-295
• Pubmed ID:
  31247193
• Pubmed Central ID:
  PMC6778013
• Document Type:
  Journal Article
• Funding:
  U2G PS001913/PS/NCHHSTP CDC HHS/United States ; T32 HD055172/HD/NICHD NIH HHS/United States ; U01 AI069911/AI/NIAID NIH HHS/United States ; UL1 TR000448/TR/NCATS NIH HHS/United States ; TL1 TR000449/TR/NCATS NIH HHS/United States ; P30 AI027757/AI/NIAID NIH HHS/United States ; UL1 TR002345/TR/NCATS NIH HHS/United States ; K23 AI120855/AI/NIAID NIH HHS/United States ; PEPFAR/PEPFAR/United States
• Place as Subject:
  Kenya
• Volume:
  100
• Issue:
  4
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:69824ca89598c527b0bc768e84b218b53f11d5343365ec2dc039bde4549077f4
• Download URL:
  https://stacks.cdc.gov/view/cdc/94466/cdc_94466_DS1.pdf
• File Type:
  [PDF - 213.18 KB ]