HIV risk associated with serum medroxyprogesterone acetate levels among women in East and southern Africa
| Autor: | Renee Heffron, Nicole L. Davis, Partners PrEP Study, Kavita Nanda, David W. Erikson, Hiv Transmission Study Teams, Nelly Mugo, Jairam R. Lingappa, Jared M. Baeten, Randy M. Stalter, Partners in Prevention Hsv, Florian Hladik, Maria Pyra, Athena P. Kourtis, Steven W. Blue |
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| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty business.industry medicine.drug_class Immunology Case-control study Odds ratio Hiv risk Confidence interval 03 medical and health sciences 030104 developmental biology 0302 clinical medicine Infectious Diseases Hormonal contraception Internal medicine Immunology and Allergy Medicine Medroxyprogesterone acetate 030212 general & internal medicine business Risk assessment Progestin medicine.drug |
| Zdroj: | AIDS. 33:735-744 |
| ISSN: | 0269-9370 |
| DOI: | 10.1097/qad.0000000000002123 |
| Popis: | Background Some observational studies have found increased HIV risk associated with self-reported use of injectable depot medroxyprogesterone acetate. Testing blood samples for medroxyprogesterone acetate (MPA), the progestin in depot medroxyprogesterone acetate, permits validation of self-reported data, and exploration of whether potential HIV risk is correlated with MPA levels, which are highest soon after injection. Methods We conducted a case-control study testing archived serum from women who participated in three longitudinal studies of HIV prevention in East and southern Africa. Case samples, from women who acquired HIV, were from visits that occurred at or immediately prior to the first evidence of HIV infection. Secondary analyses restricted to case samples collected within 15 and 30 days of the estimated date of HIV infection. Matched control samples were from women who remained HIV uninfected. We used multivariable conditional logistic regression to compare exogenous hormone levels, quantified through mass spectrometry, among cases and controls. Results When restricted to cases with samples collected within 15 days or less of estimated date of HIV infection, MPA detection was more frequent among women who acquired HIV (adjusted odds ratio = 2.75, 95% confidence interval 1.22-6.19). In this subset, the increase in HIV risk was only among samples with MPA detected at a low level of 0.02-0.50 ng/ml: 36.7% of cases and 9.4% of controls, adjusted odds ratio = 6.03, 95% confidence interval 2.50-14.54. Conclusion Detection of MPA at low levels close to the estimated time of HIV acquisition was significantly more frequent among women who acquired HIV. Studies are needed that explore biological mechanisms elicited by any MPA level and HIV risk. |
| Databáze: | OpenAIRE |
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