Hormonal contraception and metabolic outcomes in women with or at risk for HIV infection.
OBJECTIVE
The use of hormonal contraception (HC) is increasing in HIV-infected women. Both HC and HIV infection have been associated with adverse metabolic outcomes. We investigated the association of progestin-only and combined (estrogen/progestin) HC with disorders of glucose and lipid metabolism in HIV-infected and uninfected women.


METHODS
Linear mixed models evaluated the association of HC type with fasting high density lipoprotein, low density lipoprotein, triglycerides, the homeostasis model assessment estimate of insulin resistance (HOMA-IR), and glucose in 885 HIV-infected and 408 HIV-uninfected women from the Women's Interagency HIV Study seen between October 2000 and September 2005.


RESULTS
Compared with non-HC users, progestin-only HC was independently associated with lower HDL [-3 mg/dL; 95% confidence interval (CI) -5, -1 in HIV-infected and -6 mg/dL; 95% CI: -9, -3 in HIV-uninfected women] and greater HOMA-IR (+0.86; 95% CI: 0.51-1.22 and +0.56; 95% CI: 0.12-1.01). Combined HC was associated with higher HDL (+5 mg/dL; 95% CI: 2-7 and +5 mg/dL; 95% CI: 3-7).


CONCLUSIONS
HIV-infected women using progestin-only HC have lower HDL and greater HOMA-IR than HIV-infected non-HC users. Combined HC may be preferred in HIV-infected women of reproductive age at risk for cardiovascular disease, but interactions with antiretroviral therapy that may impair contraceptive efficacy have been reported. Alternative HC methods that minimize adverse outcomes but maintain efficacy require further study.
Womack
Julie A
JA
Yale University School of Nursing, New Haven, CT, USA. julie.womack@yale.edu
Scherzer
Rebecca
R
Cole
Stephen R
SR
Fennie
Kristopher
K
Williams
Ann B
AB
Grey
Margaret
M
Minkoff
Howard
H
Anastos
Kathryn
K
Cohen
Mardge H
MH
Tien
Phyllis C
PC
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D008076:Cholesterol, HDL / Q000378:metabolism; D015331:Cohort Studies; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage / Q000009:adverse effects*; D004347:Drug Interactions; D004967:Estrogens / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D044882:Glucose Metabolism Disorders / Q000139:chemically induced*; D015658:HIV Infections / Q000188:drug therapy / Q000378:metabolism*; D006801:Humans; D052439:Lipid Metabolism Disorders / Q000139:chemically induced*; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D011372:Progestins / Q000008:administration & dosage / Q000009:adverse effects; D012307:Risk Factors; D014481:United States
D019380:Anti-HIV Agents; D008076:Cholesterol, HDL; D003278:Contraceptives, Oral, Hormonal; D004967:Estrogens; D011372:Progestins; D017258:Medroxyprogesterone Acetate