Hormonal Contraception and Risk of Psychiatric and Other Noncommunicable Diseases in HIV-Infected Women.
BACKGROUND
Hormonal contraception use is common among human immunodeficiency virus (HIV)-infected women. Risk of psychiatric and other noninfectious complications of hormonal contraception use has not been described in this population.


METHODS
We performed a retrospective cohort study of HIV-infected women receiving care in Tennessee from 1998 to 2008 to examine the risks of incident psychiatric and other noncommunicable diseases (NCDs), including cardiovascular, hepatic, renal, and malignant diseases, and hormonal contraception use, including depot medroxyprogesterone acetate (DMPA) and combined estrogen- and progestin-containing hormonal contraceptives. We used marginal structural models with inverse probability weights to account for time-varying confounders associated with hormonal contraception use.


RESULTS
Of the 392 women included, 94 (24%) used hormonal contraception during the study period. Baseline psychiatric disease was similar between women who received and did not receive hormonal contraception. There were 69 incident psychiatric diagnoses and 72 NCDs. Only time-varying DMPA use was associated with increased risk of psychiatric disease (adjusted odds ratio [aOR] 3.70; 95% confidence interval [95% CI] 1.32-10.4) and mood disorders, specifically (aOR 4.70 [1.87-11.8]). Time-varying and cumulative combined hormonal contraception use were not statistically associated with other NCDs (aOR 1.64, 95% CI 0.64-4.12 and aOR 1.16, 95% CI 0.86-1.56, respectively). However, risk of incident NCDs was increased with cumulative DMPA exposure (per year exposure aOR 1.45, 95% CI 1.01-2.08).


CONCLUSIONS
Among HIV-infected women, DMPA was associated with risk of incident psychiatric diseases, particularly mood disorders, during periods of use. Cumulative DMPA exposure was also associated with risk of other NCDs. However, combined estrogen and progestin-containing hormonal contraception use was not statistically associated with risk of any NCDs.
1 Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine , Nashville, Tennessee.
Jessica L
JL
Castilho
2 Department of Biostatistics, Vanderbilt University School of Medicine , Nashville, Tennessee.
Cathy A
CA
Jenkins
2 Department of Biostatistics, Vanderbilt University School of Medicine , Nashville, Tennessee.
Bryan E
BE
Shepherd
1 Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine , Nashville, Tennessee.
Sally S
SS
Bebawy
1 Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine , Nashville, Tennessee.
Megan
M
Turner
1 Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine , Nashville, Tennessee.
Timothy R
TR
Sterling
3 Saint Thomas Rutherford Hospital , Murfreesboro, Tennessee.
Vlada V
VV
Melekhin
D000328:Adult; D015331:Cohort Studies; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000009:adverse effects*; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D015994:Incidence; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage / Q000009:adverse effects*; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D013714:Tennessee / Q000453:epidemiology; D055815:Young Adult
D003271:Contraceptive Agents, Female; D003278:Contraceptives, Oral, Hormonal; D017258:Medroxyprogesterone Acetate