title: Hormonal contraceptive use and HIV disease progression among women in Uganda and Zimbabwe.
abstract: BACKGROUND
  HIV-infected women need highly effective contraception to reduce unintended pregnancies and mother-to-child HIV transmission. Previous studies report conflicting results regarding the effect of hormonal contraception on HIV disease progression.
  
  
  METHODS
  HIV-infected women in Uganda and Zimbabwe were recruited immediately after seroconversion; CD4 testing and clinical examinations were conducted quarterly. The study end point was time to AIDS (two successive CD4 200 cells/mm or less or World Health Organization advanced Stage 3 or Stage 4 disease). We used marginal structural Cox survival models to estimate the effect of cumulative exposure to depot-medroxyprogesterone acetate and oral contraceptives on time to AIDS.
  
  
  RESULTS
  Three hundred three HIV-infected women contributed 1408 person-years. One hundred eleven women (37%) developed AIDS. Cumulative probability of AIDS was 50% at 7 years and did not vary by country. AIDS incidence was 6.6, 9.3, and 8.8 per 100 person-years for depot-medroxyprogesterone acetate, oral contraceptive, and nonhormonal users. Neither depot-medroxyprogesterone acetate (adjusted hazard ratio, 0.90; 95% confidence interval, 0.76-1.08) nor oral contraceptives ( adjusted hazard ratio, 1.07; 95% confidence interval, 0.89-1.29) were associated with HIV disease progression. Alternative exposure definitions of hormonal contraception use during the year before AIDS or at the time of HIV infection produced similar results. Sexually transmitted infection symptoms were associated with faster progression, whereas young age at HIV infection (18-24 years) was associated with slower progression. Adding baseline CD4 level and set point viral load to models did not change the hormonal contraception results, but Subtype D infection became associated with disease progression.
  
  
  CONCLUSIONS
  Hormonal contraceptive use was not associated with more rapid HIV disease progression, but older age, sexually transmitted infection symptoms, and Subtype D infection were.
authors.affiliation: Department of Clinical Sciences, Family Health International, Research Triangle Park, NC, USA. cmorrison@fhi.org
authors.forename: Charles S
authors.initials: CS
authors.lastname: Morrison
authors.forename: Pai-Lien
authors.initials: PL
authors.lastname: Chen
authors.forename: Immaculate
authors.initials: I
authors.lastname: Nankya
authors.forename: Anne
authors.initials: A
authors.lastname: Rinaldi
authors.forename: Barbara
authors.initials: B
authors.lastname: Van Der Pol
authors.forename: Yun-Rong
authors.initials: YR
authors.lastname: Ma
authors.forename: Tsungai
authors.initials: T
authors.lastname: Chipato
authors.forename: Roy
authors.initials: R
authors.lastname: Mugerwa
authors.forename: Megan
authors.initials: M
authors.lastname: Dunbar
authors.forename: Eric
authors.initials: E
authors.lastname: Arts
authors.forename: Robert A
authors.initials: RA
authors.lastname: Salata
mesh_terms: D000293:Adolescent; D000328:Adult; D003276:Contraceptives, Oral / Q000008:administration & dosage*; D003692:Delayed-Action Preparations; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000473:pathology*; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage*; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology
chemical_list: D003276:Contraceptives, Oral; D003692:Delayed-Action Preparations; D017258:Medroxyprogesterone Acetate