NDLI: Hormonal contraceptive use and HIV disease progression among women in Uganda and Zimbabwe.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Morrison, Charles S. Chen, Pai-Lien Nankya, Immaculate Rinaldi, Anne Van Der Pol, Barbara Ma, Yun-Rong Chipato, Tsungai Mugerwa, Roy Dunbar, Megan Arts, Eric Salata, Robert A.
Spatial Coverage	Uganda Zimbabwe
Description	Country affiliation: United States Author Affiliation: Morrison CS ( Department of Clinical Sciences, Family Health International, Research Triangle Park, NC, USA. cmorrison@fhi.org)
Abstract	BACKGROUND: HIV-infected women need highly effective contraception to reduce unintended pregnancies and mother-to-child HIV transmission. Previous studies report conflicting results regarding the effect of hormonal contraception on HIV disease progression. METHODS: HIV-infected women in Uganda and Zimbabwe were recruited immediately after seroconversion; CD4 testing and clinical examinations were conducted quarterly. The study end point was time to AIDS (two successive CD4 200 cells/mm or less or World Health Organization advanced Stage 3 or Stage 4 disease). We used marginal structural Cox survival models to estimate the effect of cumulative exposure to depot-medroxyprogesterone acetate and oral contraceptives on time to AIDS. RESULTS: Three hundred three HIV-infected women contributed 1408 person-years. One hundred eleven women (37%) developed AIDS. Cumulative probability of AIDS was 50% at 7 years and did not vary by country. AIDS incidence was 6.6, 9.3, and 8.8 per 100 person-years for depot-medroxyprogesterone acetate, oral contraceptive, and nonhormonal users. Neither depot-medroxyprogesterone acetate (adjusted hazard ratio, 0.90; 95% confidence interval, 0.76-1.08) nor oral contraceptives ( adjusted hazard ratio, 1.07; 95% confidence interval, 0.89-1.29) were associated with HIV disease progression. Alternative exposure definitions of hormonal contraception use during the year before AIDS or at the time of HIV infection produced similar results. Sexually transmitted infection symptoms were associated with faster progression, whereas young age at HIV infection (18-24 years) was associated with slower progression. Adding baseline CD4 level and set point viral load to models did not change the hormonal contraception results, but Subtype D infection became associated with disease progression. CONCLUSION: Hormonal contraceptive use was not associated with more rapid HIV disease progression, but older age, sexually transmitted infection symptoms, and Subtype D infection were.
File Format	HTM / HTML
ISSN	15254135
e-ISSN	10779450
DOI	10.1097/QAI.0b013e318214ba4a
Journal	JAIDS Journal of Acquired Immune Deficiency Syndromes
Issue Number	2
Volume Number	57
Language	English
Publisher	Lippincott Williams & Wilkins
Publisher Date	2011-06-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline AIDS Contraceptives, Oral Administration & Dosage Hiv Infections Epidemiology Pathology Medroxyprogesterone Acetate Adolescent Delayed-action Preparations Disease Progression Uganda Zimbabwe Research Support, N.i.h., Extramural
Content Type	Text
Resource Type	Article
Subject	Infectious Diseases Pharmacology (medical)

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