NDLI: Hormonal contraception and HIV disease progression: a multicountry cohort analysis of the MTCT-Plus Initiative.

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Hormonal contraception and HIV disease progression: a multicountry cohort analysis of the MTCT-Plus Initiative.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Stringer, Elizabeth M. Giganti, Mark Carter, Rosalind J. El-Sadr, Wafaa Abrams, Elaine J. Stringer, Jeffrey Sa
Spatial Coverage	Africa Asia
Description	Country affiliation: Zambia Author Affiliation: Stringer EM ( Center for Infectious Disease Research in Zambia, Lusaka, Zambia. eli@uab.edu)
Abstract	OBJECTIVE: HIV-infected women need access to safe and effective contraception. Recent animal and human data suggest that hormonal contraception may accelerate HIV disease progression. METHODS: We compared the incidence of HIV disease progression among antiretroviral therapy-naive women with and without exposure to hormonal contraception at 13 sites in Africa and Asia. Disease progression was defined as becoming eligible for antiretroviral therapy or death. RESULTS: Between 1 August 2002 and 31 December 2007, the MTCT-Plus programs enrolled 7846 women. In total, 4109 (52%) women met eligibility criteria for this analysis and contributed 5911 person-years of follow-up (median follow-up, 379 days; interquartile range, 121-833). At baseline, 3064 (75%) women reported using either no contraception or a nonhormonal method, whereas 823 (20%) reported using implants/injectables and 222 (5%) reported using oral contraceptive pills. The disease progression outcome was met by 944 (29%) women (rate, 18.3/100 woman-years). Neither implants/injectables (adjusted hazard ratio 1.0, 95% confidence interval 0.8-1.1) nor oral contraceptive pills (adjusted hazard ratio 0.8, 95% confidence interval 0.6-1.1) were associated with disease progression. Treating contraceptive method as a time-varying exposure did not change this negative finding. CONCLUSION: This multicountry cohort analysis provides some reassurance that hormonal contraception is not associated with HIV disease progression. Further research is needed to address the contraceptive needs of HIV-infected women.
File Format	HTM / HTML
ISSN	02699370
e-ISSN	14735571
DOI	10.1097/01.aids.0000363779.65827.e0
Journal	AIDS
Issue Number	Suppl 1
Volume Number	23
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2009-11-01
Publisher Place	Great Britain (UK)
Access Restriction	Open
Subject Keyword	Discipline Immunology Contraceptives, Oral, Hormonal Adverse Effects Disease Progression Hiv Infections Drug Therapy Hiv-1 Adolescent Africa Animals Cd4 Lymphocyte Count Cohort Studies Physiopathology Pregnancy Primates Research Support, Non-u.s. Gov't Research Support, U.s. Gov't, Non-p.h.s.
Content Type	Text
Resource Type	Article
Subject	Infectious Diseases Immunology and Allergy Immunology

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Hormonal contraception and HIV disease progression: a multicountry cohort analysis of the MTCT-Plus Initiative.