Hormonal contraceptive use and risk of HIV-1 disease progression

Abstract

Abstract Background—For HIV-1 infected women, hormonal contraception prevents unintended pregnancy, excess maternal morbidity, and vertical HIV-1 transmission. Hormonal contraceptives are widely used but their effects on HIV-1 disease progression are unclear. Methods—In a prospective study among 2269 chronically HIV-1 infected women from 7 countries in East and southern Africa and with enrollment CD4 counts ≥250 cells/mm3, we compared rates of HIV-1 disease progression among those using and not using hormonal contraception (i.e. oral or injectable methods). The primary outcome was a composite endpoint of CD4 decline to <200 cells/mm3, initiation of antiretroviral therapy, or death. Results—372 women experienced HIV-1 disease progression during 3242 years of follow up (incidence rate=11.5 events per 100 person-years). Rates of HIV-1 disease progression among women who were currently using and not using hormonal contraception were 8.54 and 12.31 per 100 person-years, respectively (adjusted hazard ratio [HR] 0.74, 95% CI 0.56–0.98, p=0.04). Rates were 8.58 and 8.39 per 100 person-years for the subsets using injectable and oral contraception (adjusted HR=0.72, p=0.04 for injectable users and adjusted HR=0.83, p=0.5 for oral users compared to women not using hormonal contraception). Sensitivity analyses assessing