Hormonal Contraception, Pregnancy, Breastfeeding, and Risk of HIV Disease Progression Among Zambian Women
| Autor: | Joseph Mulenga, William Kilembe, Susan Allen, Elwyn Chomba, Lisa B. Haddad, Shabir Lakhi, Kristin M. Wall, Naw Htee Khu, Amanda Tichacek, Ilene Brill, Bellington Vwalika |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Oral contraceptive pill breastfeeding Anti-HIV Agents Population Breastfeeding Zambia HIV Infections Cohort Studies 03 medical and health sciences 0302 clinical medicine Pregnancy Risk Factors medicine Contraceptive Agents Female Humans Pharmacology (medical) 030212 general & internal medicine education Proportional Hazards Models Gynecology Drug Implants education.field_of_study 030219 obstetrics & reproductive medicine Obstetrics business.industry hormonal contraception Hazard ratio longitudinal cohort Epidemiology and Prevention medicine.disease 3. Good health Infectious Diseases Breast Feeding Hormonal contraception Multivariate Analysis HIV disease progression Disease Progression Female business Breast feeding Unintended pregnancy |
| Zdroj: | Journal of Acquired Immune Deficiency Syndromes (1999) |
| ISSN: | 1944-7884 1525-4135 |
| Popis: | Background Some studies suggest that hormonal contraception, pregnancy, and/or breastfeeding may influence rates of HIV disease progression. Methods From 1994 to 2012, HIV discordant couples recruited at couples' voluntary HIV counseling and testing centers in Lusaka were followed 3-monthly. Multivariate survival analyses explored associations between time-varying contraception, pregnancy, and breastfeeding and 2 outcomes among HIV-positive women: (1) time to death and (2) time to antiretroviral treatment (ART) initiation. Results Among 1656 female seropositive, male seronegative couples followed for 3359 person-years (PY), 224 women died [6.7/100 PY; 95% confidence interval (CI): 5.8 to 7.6]. After 2003, 290 women initiated ART (14.5/100 PY; 95% CI: 12.9 to 16.2). In a multivariate model of time to death, hormonal implant [adjusted hazard ratio (aHR) = 0.30; 95% CI: 0.10 to 0.98] and injectable (aHR = 0.59; 95% CI: 0.36 to 0.97) were significantly protective relative to nonhormonal method use, whereas oral contraceptive pill (OCP) use was not (aHR = 1.08; 95% CI: 0.74 to 1.57) controlling for baseline HIV disease stage, time-varying pregnancy, time-varying breastfeeding, and year of enrollment. In a multivariate model of time-to-ART initiation, implant was significantly protective (aHR = 0.54; 95% CI: 0.31 to 0.95), whereas OCP (aHR = 0.70; 95% CI: 0.44 to 1.10) and injectable (aHR = 0.85; 95% CI: 0.55 to 1.32) were not relative to nonhormonal method use controlling for variables above, woman's age, and literacy. Pregnancy was not significantly associated with death (aHR = 1.07; 95% CI: 0.68 to 1.66) or ART initiation (aHR = 1.24; 95% CI: 0.83 to 1.86), whereas breastfeeding was protective for death (aHR = 0.34; 95% CI: 0.19 to 0.62) and ART initiation (aHR = 0.49; 95% CI: 0.29 to 0.85). Conclusions Hormonal implants and injectables significantly predicted lower mortality; implants were protective for ART initiation. OCPs and pregnancy were not associated with death or ART initiation, whereas breastfeeding was protective for both. Findings from this 18-year cohort study suggest that (1) HIV-positive women desiring pregnancy can be counseled to do so and breastfeed and (2) all effective contraceptive methods, including injectables and implants, should be promoted to prevent unintended pregnancy. |
| Databáze: | OpenAIRE |
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