Jim Kling

March 07, 2012

March 7, 2012 (Seattle, Washington) — Hormonal contraception does not accelerate the risk for HIV-1 disease progression in African women, according to a study presented here at the 19th Conference on Retroviruses and Opportunistic Infections.

"Our findings are reassuring. They actually suggest a possible reduced rate of HIV disease progression [in hormonal contraceptive users]," researcher Renee Heffron, a doctoral student at the University of Washington, Seattle, reported during a press conference.

Previous studies have suggested that hormonal contraceptives, which are widely used, are associated with disease progression, but results were inconsistent. Hormonal contraception is an important means of avoiding unintended pregnancy, which can lead to HIV-1 disease progression as a result of immune suppression, nutritional deficiencies, and other factors.

The researchers conducted a prospective study of 2269 women with HIV-1 infection from 7 countries in East and southern Africa. The women were part of an existing study of acyclovir to prevent transmission in HIV-1-discordant couples. CD4 counts were measured every 6 months and viral load was measured at enrollment and 6 months later.

Baseline CD4 counts were at least 250 cells/mm3. Primary outcomes included nontraumatic death, initiation of antiretroviral therapy, and decline in CD4 count to below 200 cells/mm3.

In 28 women with incident HIV-1 infection, the researchers compared the rates of CD4 decline to below 500 cells/mm3 between hormonal contraceptive users and nonusers.

At the start of the trial, 14.5% of participants used injectable hormonal contraception and 4.2% used oral hormonal contraception.

There were 377 HIV-1 disease progressions in the study population (11.5 events/100 person-years). In women using hormonal contraception, the rate was 8.54 events/100 person-years; in women not using hormonal contraception, the rate was 12.27 events/100 person-years (adjusted hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.56 to 0.99; P = .03).

In women using oral hormonal contraception, the rate was 8.39/100 person-years (HR, 0.96; 95% CI, 0.58 to 1.59; P = .8); in those using injectable hormonal contraception, the rate was 8.58/100 person-years (HR, 0.70; 95% CI, 0.51 to 0.96; P = .03).

In the group with incident HIV-1 infection, women using hormonal contraception were at lower risk for a decline in CD4 count to below 500 cells/mm3 than women who did not use hormonal contraception (31.2/100 person-years vs 92.8/100 person-years; adjusted HR, 0.30; 95% CI, 0.07 to 1.22; P = .08).

The findings are important, especially considering that young women and girls are at the greatest risk for HIV-1 infection in Africa, according to Chris Beyrer, MD, MPH, professor of epidemiology and international health at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, and the North America regional representative for the International AIDS Society.

"Happily, it looks like the answer is that it's not significantly more likely [to cause HIV disease progression]. That's very important. You never want to be in a position where you have to trade off one clinical good for another," Dr. Beyrer told Medscape Medical News.

Ms. Heffron and Dr. Beyrer have disclosed no relevant financial relationships.

19th Conference on Retroviruses and Opportunistic Infections (CROI): Abstract 21. Presented March 6, 2012.

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