Hormonal contraceptive use and risk of HIV-1 disease progression.
BACKGROUND
For HIV-1-infected women, hormonal contraception prevents unintended pregnancy, excess maternal morbidity, and vertical HIV-1 transmission. Hormonal contraceptives are widely used but their effects on HIV-1 disease progression are unclear.


METHODS
In a prospective study among 2269 chronically HIV-1-infected women from seven countries in eastern and southern Africa and with enrollment CD4 cell counts at least 250 cells/μl, we compared rates of HIV-1 disease progression among those using and not using hormonal contraception (i.e. oral or injectable methods). The primary outcome was a composite endpoint of CD4 decline to less than 200 cells/μl, initiation of antiretroviral therapy, or death.


RESULTS
Three hundred and seventy-two women experienced HIV-1 disease progression during 3242 years of follow-up (incidence rate = 11.5 events per 100 person-years). Rates of HIV-1 disease progression among women who were currently using and not using hormonal contraception were 8.54 and 12.31 per 100 person-years, respectively (adjusted hazard ratio 0.74, 95% confidence interval 0.56-0.98, P = 0.04). Rates were 8.58 and 8.39 per 100 person-years for the subsets using injectable and oral contraception (adjusted hazard ratio = 0.72, P = 0.04 for injectable users and adjusted hazard ratio = 0.83, P = 0.5 for oral users compared to women not using hormonal contraception). Sensitivity analyses assessing enrollment or cumulative contraceptive use during the study demonstrated risk estimates closer to 1.0 with no evidence for accelerated disease progression.


CONCLUSIONS
Among African women with chronic HIV-1 infection, use of hormonal contraception was not associated with deleterious consequences for HIV-1 disease progression.
Department of Epidemiology, University of Washington, Seattle, Washington 98104, USA.
Renee
R
Heffron
Nelly
N
Mugo
Kenneth
K
Ngure
Connie
C
Celum
Deborah
D
Donnell
Edwin
E
Were
Helen
H
Rees
James
J
Kiarie
Jared M
JM
Baeten
D000328:Adult; D000351:Africa, Eastern; D000353:Africa, Southern; D018791:CD4 Lymphocyte Count; D003268:Contraception Behavior; D003278:Contraceptives, Oral, Hormonal; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000635:transmission*; D006679:HIV Seropositivity / Q000635:transmission*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D011247:Pregnancy; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment
D003278:Contraceptives, Oral, Hormonal