Associations of hormonal contraceptive use with measures of HIV disease progression and antiretroviral therapy effectiveness.

OBJECTIVE: To examine the associations between hormonal contraceptive use and measures of HIV disease progression and antiretroviral treatment (ART) effectiveness. STUDY DESIGN: A prospective cohort study of women with prevalent HIV infection in St. Petersburg, Russia, was conducted. After contraceptive counseling, participants chose to use combined oral contraceptives (COCs), depot-medroxyprogesterone acetate (DMPA), a copper intrauterine device (IUD) or male condoms for pregnancy prevention. Among participants not using ART at enrollment, we used multivariate Cox regression to assess the association between current (time-varying) contraceptive use and disease progression, measured by the primary composite outcome of CD4 decline to <350 cells/mm(3), ART initiation or death. Among participants using ART at enrollment, we used linear mixed models to estimate the predicted mean CD4 change at select time points by contraceptive method. RESULTS: During a total of 5233 months follow-up among participants not using ART with enrollment CD4 ≥350 cells/mm(3) (n=315), 97 experienced disease progression. Neither current use of COCs [adjusted hazard ratio (aHR) 0.91, 95% confidence interval (CI) 0.56-1.48] nor DMPA (aHR 1.28, 95% CI 0.71-2.31) was associated with a statistically significant increased risk for disease progression compared with use of nonhormonal methods (IUD or condoms). Among participants using ART at enrollment (n=77), we found no statistically significant differences in the predicted mean changes in CD4 cell count comparing current use of COCs (p=.1) or DMPA (p=.3) with nonhormonal methods. CONCLUSION: Hormonal contraceptive use was not significantly associated with measures of HIV disease progression or ART effectiveness among women with prevalent HIV infection. IMPLICATIONS: Hormonal contraceptive use was not significantly associated with measures of HIV disease progression or ART effectiveness among women with prevalent HIV infection.

Determinants of contraceptive choice among women with HIV.

OBJECTIVE: To examine factors associated with contraceptive choice among HIV-infected women. DESIGN: Data for this cross-sectional analysis were derived from baseline visits of 435 participants in an ongoing prospective study of contraception among HIV-infected women in Russia. Participants enrolled in one of four groups: combined oral contraceptives (COCs) along with condoms, depot medroxyprogesterone acetate (DMPA) along with condoms, copper intrauterine device (IUD) along with condoms, or condoms alone. METHODS: After contraceptive counseling and assessment of medical eligibility to use study methods, participants selected a method. Standardized interviews were used to collect demographic, reproductive and behavioral information. RESULTS: Most women were eligible to use COCs (89%) and DMPA (94%); 87% of nonpostpartum women were eligible to use the IUD. The method chosen by most women was condoms alone (47%), followed by COCs along with condoms (29%), DMPA along with condoms (20%) and IUD along with condoms (4%). In multivariable analyses, independent predictors of choosing a method highly effective during typical use (COCs, DMPA, or IUD) along with condoms included having at least two births (prevalence ratio = 1.4), postpartum enrollment (prevalence ratio = 1.3), desiring (prevalence ratio = 1.4), or uncertainty about desiring (prevalence ratio = 1.3) a future pregnancy, prior oral contraceptive use (prevalence ratio = 1.3), recent injection drug use (prevalence ratio = 1.3) and never (prevalence ratio = 2.3) or sometimes (prevalence ratio = 1.9) using condoms in the last year. CONCLUSION: Among HIV-infected women, several characteristics that may place women at greater risk for unintended pregnancy and its adverse consequences were associated with choice of highly effective contraceptive methods. These findings may aid in the development of interventions to increase use of effective contraception among HIV-infected women.