Associations of Hormonal Contraceptive Use with Measures of HIV Disease Progression & Antiretroviral Therapy Effectiveness

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 <350cells/mm(3), 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 5233months follow-up among participants not using ART with enrollment CD4 ≥350cells/mm(3) (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.

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By:   Whiteman MK1, Jeng G2, Samarina A3, Akatova N3, Martirosyan M3, Kissin DM2, Curtis KM2, Marchbanks PA2, Hillis SD2, Mandel MG2, Jamieson DJ2.

• 1Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: acq5@cdc.gov.
• 2Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
• 3St. Petersburg AIDS Center, St. Petersburg, Russia.
• Contraception. 2016 Jan;93(1):17-24. doi: 10.1016/j.contraception.2015.07.003. Epub 2015 Jul 18.
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