title: Sexually transmitted infections and use of contraceptives in women living with HIV in Denmark - the SHADE cohort.
abstract: BACKGROUND
  No Danish guidelines for screening of sexually transmitted infections (STIs) in women living with HIV (WLWH) exist, except for annual syphilis testing. Drug-drug interaction between hormonal contraceptives and some types of highly active antiretroviral therapy (HAART) occurs. We assessed prevalence of STIs, contraceptive choices and predictors of condom use in a cohort of WLWH in Denmark.
  
  
  METHODS
  WLWH consecutively enrolled during their outpatient visits from 2011 to 2012. Gynaecological examination and an interview were performed at entry and 6-month follow-up. Inclusion criteria were HIV-1 infection and ≥ 18 years of age. Exclusion criteria were pregnancy, alcohol- or drug abuse impeding adherence to the protocol. At entry, participants were tested (and where appropriate, treated according to guidelines) for Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis, and herpes simplex (HSV-1 and HSV-2). At follow-up, predictors of condom use were estimated in sexually active WLWH.
  
  
  RESULTS
  In total, 334 of the 1,392 eligible WLWH in Denmark were included (median age and HIV duration: 42.5 and 11.3 years). Chlamydia trachomatis was present in four individuals (1 %), and six (2 %) tested positive for HSV-2 by PCR. None were positive for Neisseria gonorrhoeae, HSV-1 or had active syphilis. At follow-up, 252 (76 %) participated; 168 (70 %) were sexually active. Contraceptives were used by 124 (75 %); condoms were preferred (62 %). Having an HIV-negative partner predicted condom use (adjusted OR 3.89 (95 %CI 1.49-10.11)). In the group of participants of reproductive age without pregnancy desires 13 % used no birth-control. Possible drug-drug interaction between hormonal contraceptives and HAART was found in 13/14 WLWH receiving both kinds of medication.
  
  
  CONCLUSIONS
  The prevalence of STIs in WLWH in Denmark was low. The need for annual STI screening is questionable. Condoms were preferred contraceptives, especially in WLWH with an HIV-negative partner. In this cohort, 13 % of WLWH of reproductive age were at risk of unintended pregnancies due to lack of birth-control. Finally, in the subgroup of WLWH receiving both hormonal contraceptives and HAART possible drug-drug interactions could occur.
authors.affiliation: Department of Infectious Diseases, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark. kristina.thorsteinsson@gmail.com.
authors.forename: Kristina
authors.initials: K
authors.lastname: Thorsteinsson
authors.affiliation: Clinical Research Center, Hvidovre, Copenhagen University Hospital, Hvidovre, Denmark.
authors.forename: Steen
authors.initials: S
authors.lastname: Ladelund
authors.affiliation: Department of Infectious Diseases, Skejby, Aarhus University Hospital, Aarhus, Denmark.
authors.forename: Merete
authors.initials: M
authors.lastname: Storgaard
authors.affiliation: Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Frederikke Falkencrone
authors.initials: FF
authors.lastname: Rønsholt
authors.affiliation: Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.
authors.forename: Isik Somuncu
authors.initials: IS
authors.lastname: Johansen
authors.affiliation: Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Gitte
authors.initials: G
authors.lastname: Pedersen
authors.affiliation: Department of Infectious Diseases, Hillerød Hospital, Hillerød, Denmark.
authors.forename: Lars Nørregård
authors.initials: LN
authors.lastname: Nielsen
authors.affiliation: Department of Pathology, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Jesper
authors.initials: J
authors.lastname: Bonde
authors.affiliation: Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.|Department of Clinical Microbiology, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark.
authors.forename: Henrik
authors.initials: H
authors.lastname: Westh
authors.affiliation: Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.|Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Niels
authors.initials: N
authors.lastname: Obel
authors.affiliation: Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.|Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Terese L
authors.initials: TL
authors.lastname: Katzenstein
authors.affiliation: Department of Infectious Diseases, Hvidovre, Copenhagen University Hospital, Copenhagen, Denmark.|Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Anne-Mette
authors.initials: AM
authors.lastname: Lebech
mesh_terms: D000293:Adolescent; D000328:Adult; D017280:Condoms / Q000706:statistics & numerical data*; D003267:Contraception / Q000379:methods / Q000706:statistics & numerical data*; D003718:Denmark; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications*; D015497:HIV-1; D006561:Herpes Simplex / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D018259:Herpesvirus 1, Human / Q000302:isolation & purification; D018258:Herpesvirus 2, Human / Q000302:isolation & purification; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D015231:Sexually Transmitted Diseases, Bacterial / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D055815:Young Adult