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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Hormonal contraceptive use and HIV disease progression among women in Uganda and Zimbabwe
Journal of Acquired Immune Deficiency Syndromes, Volume 57, No. 2, Year 2011
Notification
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Description
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. © 2011 Lippincott Williams & Wilkins.
Authors & Co-Authors
Morrison, Charles S.
United States, Durham
Fhi 360
Chen, Pai Lien
Unknown Affiliation
Nankya, Immaculate L.
Uganda, Kampala
Joint Clinical Research Center Uganda
Rinaldi, Anne
United States, Durham
Fhi 360
van der Pol, Barbara J.
United States, Bloomington
Indiana University Bloomington
Ma, Yun Rong
Unknown Affiliation
Chipato, Tsungai
Zambia, Harare
University of Zimbabwe
Mugerwa, Roy D.
Uganda, Kampala
Makerere University
Dunbar, Megan S.
United States, Research Triangle Park
Rti International
Arts, Eric J.
United States, Cleveland
Case Western Reserve University
Salata, Robert A.
United States, Cleveland
Case Western Reserve University
Statistics
Citations: 44
Authors: 11
Affiliations: 7
Identifiers
Doi:
10.1097/QAI.0b013e318214ba4a
ISSN:
15254135
Research Areas
Environmental
Health System And Policy
Infectious Diseases
Maternal And Child Health
Sexual And Reproductive Health
Study Design
Cohort Study
Study Locations
Uganda
Zimbabwe
Participants Gender
Female