title: Brief Report: Hormonal Contraception Is Not Associated With Reduced ART Effectiveness Among Women Initiating ART: Evidence From Longitudinal Data.
abstract: To explore the association between concomitant hormonal contraceptive and antiretroviral therapy (ART) use and (1) plasma viral suppression and (2) genital HIV shedding among HIV-positive women initiating ART.
  
  
  
  We analyzed plasma viral load and genital viral RNA shedding from 1079 HIV-positive women initiating ART who were followed prospectively in 3 sub-Saharan African HIV prevention studies. Plasma and endocervical swab samples were collected every 6 months. Self-reported contraceptive use was categorized into injectable, implant, oral, or nonhormonal/no contraception. We used multivariate Cox regression to assess time to plasma viral suppression and logistic regression with generalized estimating equations to assess genital viral shedding for each contraceptive method.
  
  
  
  At the time of ART initiation, there were 211 (20%) injectable, 69 (6%) implant, 50 (5%) oral, and 749 (69%) nonhormonal or no method users. Plasma viral suppression was high (90% by 6 months) and hormonal contraceptives did not diminish time to plasma viral suppression as compared to nonhormonal/no methods [adjusted hazard ratios: injectables 0.89 (95% confidence interval: 0.75 to 1.07), implants 0.91 (0.68 to 1.23), and oral methods 1.33 (1.06 to 1.66)]. Genital viral shedding was uncommon any time after ART initiation (only 9% of samples had detectable viral shedding) and hormonal contraceptives were not associated with an increased detection of genital viral shedding [adjusted odds ratios: injectables 1.07 (0.69 to 1.65), implants 0.67 (0.31 to 1.49), and oral methods 0.56 (0.19 to 1.69)].
  
  
  
  The hormonal contraceptives assessed were not associated with reduced ART effectiveness among HIV-positive women initiating ART. HIV-positive women should continue to be offered contraceptive options, including hormonal ones that best meet their needs.
authors.affiliation: Departments of *Medicine;†Global Health;‡Epidemiology, University of Washington, Seattle, WA;§Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA;‖FHI 360, Integrated Health Sciences, Research Triangle Park, NC;¶Department of Obstetrics and Gynecology, University of Washington, Seattle, WA;#Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya; and**Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya.
authors.forename: Rena C
authors.initials: RC
authors.lastname: Patel
authors.forename: Jared M
authors.initials: JM
authors.lastname: Baeten
authors.forename: Renee
authors.initials: R
authors.lastname: Heffron
authors.forename: Ting
authors.initials: T
authors.lastname: Hong
authors.forename: Nicole L
authors.initials: NL
authors.lastname: Davis
authors.forename: Kavita
authors.initials: K
authors.lastname: Nanda
authors.forename: Robert W
authors.initials: RW
authors.lastname: Coombs
authors.forename: Jairam R
authors.initials: JR
authors.lastname: Lingappa
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.forename: Stacey
authors.initials: S
authors.lastname: Hurst
authors.forename: Katherine K
authors.initials: KK
authors.lastname: Thomas
authors.forename: Athena P
authors.initials: AP
authors.lastname: Kourtis
authors.forename: Nelly
authors.initials: N
authors.lastname: Mugo
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara; D044966:Anti-Retroviral Agents / Q000008:administration & dosage*; D002584:Cervix Uteri / Q000821:virology; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage*; D004347:Drug Interactions; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008137:Longitudinal Studies; D012367:RNA, Viral / Q000097:blood; D016896:Treatment Outcome; D019562:Viral Load; D017201:Virus Shedding
chemical_list: D044966:Anti-Retroviral Agents; D003278:Contraceptives, Oral, Hormonal; D012367:RNA, Viral