Some studies suggest hormonal contraception, pregnancy,
and/or breastfeeding may influence rates of HIV disease progression.
From 1994-2012, HIV discordant couples recruited at couples'
voluntary HIV counseling and testing centers in Lusaka were followed 3-monthly.
Multivariate survival analyses explored associations between time-varying
contraception, pregnancy, and breastfeeding and two outcomes among HIV-positive
women: 1) time-to-death and 2) time-to-antiretroviral treatment (ART)
initiation.
Among 1,656 female seropositive, male seronegative couples
followed for 3,359 person years (PY), 224 women died.
After 2003, 290 women initiated ART. In a
multivariate model of time-to-death, hormonal implant and injectable were
significantly protective relative to non-hormonal method use while OCP use was
not controlling for baseline HIV disease stage,
time-varying pregnancy, time-varying breastfeeding, and year of enrollment. In
a multivariate model of time-to-ART initiation, implant was protective while OCP and injectable were not relative to non-hormonal method use
controlling for variables above, woman's age, and literacy. Pregnancy was not
significantly associated with death or ART
initiation while breastfeeding was protective for
death and ART initiation.
Hormonal implants and injectables significantly predicted
lower mortality; implants were protective for ART initiation. OCPs and
pregnancy were not associated with death or ART initiation, while breastfeeding
was protective for both.
Findings from this 18-year cohort study suggest 1)
HIV-positive women desiring pregnancy can be counseled to do so and breastfeed,
and 2) all effective contraceptive methods including injectables and implants
should be promoted to prevent unintended pregnancy.
By: Wall KM1, Kilembe W, Haddad L, Vwalika B, Lakhi S, Htee Khu N, Brill I, Chomba E, Mulenga J, Tichacek A, Allen S.
- 1aRwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA bDepartment of Epidemiology, Rollins School of Public Health, Laney Graduate School, Emory University, Atlanta, Georgia, USA cDepartment of Gynecology and Obstetrics, Emory University, School of Medicine, Atlanta, Georgia, USA dDepartments of Gynecology and Obstetrics (BV) and Internal Medicine (SL), School of Medicine, University of Zambia, Lusaka, Zambia eDepartment of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA fMinistry of Community Development, Mother and Child Health, Lusaka, Zambia.
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