NDLI: Hormonal contraceptive use and risk of HIV-1 disease progression.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Heffron, Renee Mugo, Nelly Ngure, Kenneth Celum, Connie Donnell, Deborah Were, Edwin Rees, Helen Kiarie, James Baeten, Jared M.
Spatial Coverage	Africa, Eastern Africa, Southern
Description	Country affiliation: United States Author Affiliation: Heffron R ( Department of Epidemiology, University of Washington, Seattle, Washington 98104, USA.)
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 seven countries in eastern and southern Africa and with enrollment CD4 cell counts at least 250âcells/µl, 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 less than 200âcells/µl, initiation of antiretroviral therapy, or death. RESULTS: Three hundred and seventy-two women experienced HIV-1 disease progression during 3242 years of follow-up (incidence rateâ=â11.5 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 0.74, 95% confidence interval 0.56-0.98, Pâ=â0.04). Rates were 8.58 and 8.39 per 100 person-years for the subsets using injectable and oral contraception (adjusted hazard ratioâ=â0.72, Pâ=â0.04 for injectable users and adjusted hazard ratioâ=â0.83, Pâ=â0.5 for oral users compared to women not using hormonal contraception). Sensitivity analyses assessing enrollment or cumulative contraceptive use during the study demonstrated risk estimates closer to 1.0 with no evidence for accelerated disease progression. CONCLUSION: Among African women with chronic HIV-1 infection, use of hormonal contraception was not associated with deleterious consequences for HIV-1 disease progression.
File Format	HTM / HTML
ISSN	02699370
e-ISSN	14735571
DOI	10.1097/QAD.0b013e32835ad473
Journal	AIDS
Issue Number	2
Volume Number	27
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2013-01-14
Publisher Place	Great Britain (UK)
Access Restriction	Open
Subject Keyword	Discipline Immunology Contraceptives, Oral, Hormonal Hiv Infections Transmission Hiv Seropositivity Infectious Disease Transmission, Vertical Prevention & Control Africa, Eastern Africa, Southern Cd4 Lymphocyte Count Contraception Behavior Disease Progression Diagnosis Pregnancy Prospective Studies Randomized Controlled Trials As Topic Risk Assessment Research Support, N.i.h., Extramural Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Infectious Diseases Immunology and Allergy Immunology

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