Sexually Transmitted Infections and Use of Contraceptives in Women Living with HIV in Denmark - The SHADE Cohort
BACKGROUND:
No
Danish guidelines for screening of sexually transmitted infections (STIs) in
women living with HIV (WLWH) exist, except for annual syphilis testing.
Drug-drug interaction between hormonal contraceptives and some types of highly
active antiretroviral therapy (HAART) occurs. We assessed prevalence of STIs,
contraceptive choices and predictors of condom use in a cohort of WLWH in
Denmark.
METHODS:
WLWH
consecutively enrolled during their outpatient visits from 2011 to 2012.
Gynaecological examination and an interview were performed at entry and 6-month
follow-up. Inclusion criteria were HIV-1 infection and ≥ 18 years of age.
Exclusion criteria were pregnancy, alcohol- or drug abuse impeding adherence to
the protocol. At entry, participants were tested (and where appropriate,
treated according to guidelines) for Chlamydia trachomatis, Neisseria
gonorrhoeae, syphilis, and herpes simplex (HSV-1 and HSV-2). At follow-up,
predictors of condom use were estimated in sexually active WLWH.
RESULTS:
In total,
334 of the 1,392 eligible WLWH in Denmark were included (median age and HIV
duration: 42.5 and 11.3 years). Chlamydia trachomatis was present in four
individuals (1 %), and six (2 %) tested positive for HSV-2 by PCR.
None were positive for Neisseria gonorrhoeae, HSV-1 or had active syphilis. At
follow-up, 252 (76 %) participated; 168 (70 %) were sexually active.
Contraceptives were used by 124 (75 %); condoms were preferred (62 %).
Having an HIV-negative partner predicted condom use (adjusted OR 3.89 (95 %CI
1.49-10.11)). In the group of participants of reproductive age without
pregnancy desires 13 % used no birth-control. Possible drug-drug
interaction between hormonal contraceptives and HAART was found in 13/14 WLWH
receiving both kinds of medication.
CONCLUSION:
The
prevalence of STIs in WLWH in Denmark was low. The need for annual STI
screening is questionable. Condoms were preferred contraceptives, especially in
WLWH with an HIV-negative partner. In this cohort, 13 % of WLWH of
reproductive age were at risk of unintended pregnancies due to lack of
birth-control. Finally, in the subgroup of WLWH receiving both hormonal
contraceptives and HAART possible drug-drug interactions could occur.
By: Thorsteinsson K1, Ladelund S2, Storgaard M3, Rønsholt FF4, Johansen IS5, Pedersen G6, Nielsen LN7, Bonde J8, Westh H9,10, Obel N4,9, Katzenstein TL4,9,Lebech AM11,9.
- 1Department of Infectious Diseases, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark. kristina.thorsteinsson@gmail.com.
- 2Clinical Research Center, Hvidovre, Copenhagen University Hospital, Hvidovre, Denmark.
- 3Department of Infectious Diseases, Skejby, Aarhus University Hospital, Aarhus, Denmark.
- 4Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
- 5Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
- 6Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
- 7Department of Infectious Diseases, Hillerød Hospital, Hillerød, Denmark.
- 8Department of Pathology, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark.
- 9Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
- 10Department of Clinical Microbiology, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark.
- 11Department of Infectious Diseases, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark.
- BMC Infect Dis. 2016 Feb 16;16(1):81. doi: 10.1186/s12879-016-1412-7.
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