Injectable and oral contraception and the incidence and progression of cervical disease in HIV-infected women in South Africa.
BACKGROUND
Few data exist regarding the effect of hormonal contraception (HC) on incidence and progression of cervical disease (e.g., cervical dysplasia, squamous intraepithelial lesions, cervical intraepithelial neoplasia) in HIV-infected African women.


METHODS
We conducted an observational study of HIV-seropositive women in Johannesburg, South Africa. The effect of individual HC types on the incidence and progression of cervical disease was determined using Poisson regression to obtain adjusted incidence rate ratios.


RESULTS
We evaluated 594 HIV-infected women, with median follow-up time of 445 days; 75 of these women were receiving some form of HC (largely DMPA, NET-EN, or COCs) at baseline. Risks of incidence and progression of cervical disease were similar comparing women not receiving HCs to women receiving DMPA, NET-EN, or COCs both individually by HC-type and considering all HC together.


CONCLUSIONS
There was no statistically significant effect of particular HC methods or of HC use in general on rates of incidence or progression of cervical disease in this study. These results should reassure us that use of HC is unlikely to substantially increase risks of cervical disease among HIV-positive women.
Department of Obstetrics and Gynecology and Duke Global Health Institute, Duke University, Durham, NC, USA. Electronic address: westreic@email.unc.edu.
Daniel
D
Westreich
Department of Family Medicine, University of Texas Medical Branch, Galveston, TX, USA.
Naiomi
N
Jamal
Department of Epidemiology, Gillings School of Global Public Health and Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
Jennifer S
JS
Smith
Clinical HIV Research Unit, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Doreen
D
Schulze
Right to Care, Johannesburg, South Africa.
Sophie
S
Williams
Cytology Unit, National Health Laboratory Service and Department of Pathology, University of Witwatersrand, Johannesburg, South Africa.
Pam
P
Michelow
Right to Care, Johannesburg, South Africa; Department of Obstetrics and Gynecology, Rahima Moosa Mother and Child Hospital, University of Witwatersrand, Johannesburg, South Africa.
Simon
S
Levin
Clinical HIV Research Unit, Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Right to Care, Johannesburg, South Africa.
Cynthia
C
Firnhaber
D000328:Adult; D003271:Contraceptive Agents, Female / Q000009:adverse effects*; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008875:Middle Aged; D013019:South Africa / Q000453:epidemiology; D002578:Uterine Cervical Dysplasia / Q000453:epidemiology* / Q000209:etiology; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology* / Q000209:etiology
D003271:Contraceptive Agents, Female
Cervical disease; Combined oral contraceptives; DMPA, HIV, NET-EN