title: Associations of hormonal contraceptive use with measures of HIV disease progression and antiretroviral therapy effectiveness.
abstract: OBJECTIVE
  To examine the associations between hormonal contraceptive use and measures of HIV disease progression and antiretroviral treatment (ART) effectiveness.
  
  
  METHODS
  A prospective cohort study of women with prevalent HIV infection in St. Petersburg, Russia, was conducted. After contraceptive counseling, participants chose to use combined oral contraceptives (COCs), depot-medroxyprogesterone acetate (DMPA), a copper intrauterine device (IUD) or male condoms for pregnancy prevention. Among participants not using ART at enrollment, we used multivariate Cox regression to assess the association between current (time-varying) contraceptive use and disease progression, measured by the primary composite outcome of CD4 decline to <350 cells/mm(3), ART initiation or death. Among participants using ART at enrollment, we used linear mixed models to estimate the predicted mean CD4 change at select time points by contraceptive method.
  
  
  RESULTS
  During a total of 5233 months follow-up among participants not using ART with enrollment CD4 ≥350 cells/mm(3) (n=315), 97 experienced disease progression. Neither current use of COCs [adjusted hazard ratio (aHR) 0.91, 95% confidence interval (CI) 0.56-1.48] nor DMPA (aHR 1.28, 95% CI 0.71-2.31) was associated with a statistically significant increased risk for disease progression compared with use of nonhormonal methods (IUD or condoms). Among participants using ART at enrollment (n=77), we found no statistically significant differences in the predicted mean changes in CD4 cell count comparing current use of COCs (p=.1) or DMPA (p=.3) with nonhormonal methods.
  
  
  CONCLUSIONS
  Hormonal contraceptive use was not significantly associated with measures of HIV disease progression or ART effectiveness among women with prevalent HIV infection.
  
  
  CONCLUSIONS
  Hormonal contraceptive use was not significantly associated with measures of HIV disease progression or ART effectiveness among women with prevalent HIV infection.
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. Electronic address: acq5@cdc.gov.
authors.forename: Maura K
authors.initials: MK
authors.lastname: Whiteman
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Gary
authors.initials: G
authors.lastname: Jeng
authors.affiliation: St. Petersburg AIDS Center, St. Petersburg, Russia.
authors.forename: Anna
authors.initials: A
authors.lastname: Samarina
authors.affiliation: St. Petersburg AIDS Center, St. Petersburg, Russia.
authors.forename: Natalia
authors.initials: N
authors.lastname: Akatova
authors.affiliation: St. Petersburg AIDS Center, St. Petersburg, Russia.
authors.forename: Margarita
authors.initials: M
authors.lastname: Martirosyan
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Dmitry M
authors.initials: DM
authors.lastname: Kissin
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Curtis
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Polly A
authors.initials: PA
authors.lastname: Marchbanks
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Susan D
authors.initials: SD
authors.lastname: Hillis
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Michele G
authors.initials: MG
authors.lastname: Mandel
authors.affiliation: Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D017280:Condoms; D003271:Contraceptive Agents, Female / Q000008:administration & dosage / Q000009:adverse effects; D003277:Contraceptives, Oral, Combined / Q000009:adverse effects* / Q000627:therapeutic use; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects* / Q000627:therapeutic use; D003692:Delayed-Action Preparations / Q000008:administration & dosage / Q000009:adverse effects; D018450:Disease Progression; D004347:Drug Interactions; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007273:Injections, Intramuscular; D007434:Intrauterine Devices; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents; D003271:Contraceptive Agents, Female; D003277:Contraceptives, Oral, Combined; D003278:Contraceptives, Oral, Hormonal; D003692:Delayed-Action Preparations; D017258:Medroxyprogesterone Acetate
keywords: Antiretroviral agents/therapeutic use; CD4 lymphocyte count; Contraceptive agents; Female/administration and dosage/adverse effects; HIV seropositivity/complications/drug therapy/mortality