Disease Progression Among HIV-1 Infected Women Using Hormonal and Non-Hormonal Contraceptive Methods in Kenya and Zimbabwe

Abstract

An estimated 18 million women of reproductive age are infected with HIV-1 worldwide with over 80% living in sub-Saharan Africa. Hormonal contraceptive (HC) use is common in women of reproductive age. However, its effect on HIV-1 disease progression is unknown. The overall objective of this study was to determine the effects of combined oral contraceptives (COC) anddepot medroxyprogesterone (DMPA) on the rate of CD4 change, HIV-1 RNA levels and clinical progression in HIV-1 infected women in Kenya and Zimbabwe. A total of 498 subjects were enrolled. Of the 365 (81.3%) who used their contraceptive method consistently for a mean (range) follow up period of 2 (0-4) years, 135 (37.2%) used DMPA, 86 (23.6%) used COC and 144 (39.4%) used non-hormonal (non-HC) methods. DMPA and COC users had a similar change in CD4 cell count in comparison to women using non-HC methods (mean log10 CD4 cells/mcL change per 6-months = 0.011; 95% CI, - 0.019 to 0.042, and -0.001; 95% CI -0.034 to 0.031, respectively). Change in HIV-1 viral load was not significantly different for DMPA or COC users compared with non-HC users (log10 HIV-1 RNA copies/mL change per 6- months = -0.013; 95% CI, -0.208 to 0.183 and -0.104; 95% CI -0.311 to 0.103, respectively). Time to WHO clinical stage III/IV was similar among DMPA (adjusted (A) HR = 0.94; 95% CI 0.46 to 1.90) and COC (AHR = 0.82; 95% CI0.35 to 1.90) users compared with non-HC users. This is the first study that was designed to investigate effects of HC on the natural history of HIV-1 infected women in the general population in sub-Saharan Africa where women continue the use of these methods. In this investigation HC use was not associated with HIV-1 disease progression among women with CD4 above 350 cells/mcL.