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.
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.
- More at: https://twitter.com/hiv
insight
- And: http://twitter.com/Prison
Health
Below: Cumulative rates of IUD expulsion in groups (%)
The cumulative expulsion rates were similar with a frequency of 8.7, 8.9 and 11.3 % respectively in groups 1 to 3 (p > 0.05 in all pairwise comparisons). The rate of patients who had the IUD removed at 12th month was 4,3, 6.7 and 11.3 % for groups 1, 2 and 3 respectively (p > 0.05 in all pairwise comparisons). Multiparity increased the risk of cumulative expulsion within 12 months by 2.1 fold (95 % 1,03–4,37) in the logistic regression model. Previous vaginal deliveries or IUD use did not have an impact on the expulsion of the IUD. The risk of spontaneous expulsion was similar in patients whose IUD was placed after cesarean in the active and latent phase or after spontaneous vaginal delivery.
The rates of IUD expulsion are similar in patients who underwent cesarean section before and during labor and who delivered vaginally. Parity was the only factor independently associated with IUD expulsion.
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