Hormonal contraception and risk of cervical infections among HIV-1-seropositive Kenyan women.
OBJECTIVE
To evaluate the relationship between hormonal contraceptive use and the acquisition of cervical sexually transmitted infections (STI) among HIV-1-infected women.


METHODS
A prospective cohort study of 242 commercial sex workers in Mombasa, Kenya, followed from the time of HIV-1 infection.


METHODS
At monthly follow-up visits, sexual behavior and contraceptive use were recorded, and laboratory screening for STI was performed. Multivariate Andersen-Gill proportional hazards models were constructed to examine the association between the use of hormonal contraception and the occurrence of cervical STI.


RESULTS
The median duration of follow-up after HIV-1 acquisition was 35 months, and 799 person-years of follow-up were accrued. After adjustment for demographic factors and sexual behavior, women using the injectable contraceptive depot medroxyprogesterone acetate were at increased risk of Chlamydia trachomatis infection [hazard ratio (HR) 3.1, 95% confidence interval (CI) 1.0-9.4, P = 0.05] and cervicitis (HR 1.6, 95% CI 1.0-2.3, P = 0.03) compared with women using no contraception. The use of oral contraceptive pills was associated with an increased risk of cervicitis (HR 2.3, 95% CI 1.4-3.8, P = 0.001). Hormonal contraception was not associated with an increased risk of infection with Neisseria gonorrhoeae.


CONCLUSIONS
The use of hormonal contraception by HIV-1-infected women was associated with an increased risk of cervicitis and cervical chlamydia infection. HIV-1-seropositive women using hormonal contraception should be counseled about the importance of consistent condom use to prevent both STI and HIV-1 transmission.
Lavreys
Ludo
L
Departments of Epidemiology and Medicine, University of Washington, Seattle 98104-2499, USA. llavreys@africaonline.co.ke
Chohan
Varsha
V
Overbaugh
Julie
J
Hassan
Wisal
W
McClelland
R Scott
RS
Kreiss
Joan
J
Mandaliya
Kishorchandra
K
Ndinya-Achola
Jeckoniah
J
Baeten
Jared M
JM
D000328:Adult; D002690:Chlamydia Infections / Q000635:transmission; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage*; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D006679:HIV Seropositivity; D015497:HIV-1; D006801:Humans; D007275:Injections, Intravenous; D007630:Kenya; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D011477:Sex Work; D012749:Sexually Transmitted Diseases / Q000635:transmission; D002575:Uterine Cervicitis / Q000209:etiology*
D003278:Contraceptives, Oral, Hormonal; D017258:Medroxyprogesterone Acetate