Hormonal contraception and risk of cervical infections among HIV-1-seropositive Kenyan women.

Abstract

OBJECTIVE:

To evaluate the relationship between hormonal contraceptive use and the acquisition of cervical sexually transmitted infections (STI) among HIV-1-infected women.

DESIGN:

A prospective cohort study of 242 commercial sex workers in Mombasa, Kenya, followed from the time of HIV-1 infection.

METHODS:

At monthly follow-up visits, sexual behavior and contraceptive use were recorded, and laboratory screening for STI was performed. Multivariate Andersen-Gill proportional hazards models were constructed to examine the association between the use of hormonal contraception and the occurrence of cervical STI.

RESULTS:

The median duration of follow-up after HIV-1 acquisition was 35 months, and 799 person-years of follow-up were accrued. After adjustment for demographic factors and sexual behavior, women using the injectable contraceptive depot medroxyprogesterone acetate were at increased risk of Chlamydia trachomatis infection [hazard ratio (HR) 3.1, 95% confidence interval (CI) 1.0-9.4, P = 0.05] and cervicitis (HR 1.6, 95% CI 1.0-2.3, P = 0.03) compared with women using no contraception. The use of oral contraceptive pills was associated with an increased risk of cervicitis (HR 2.3, 95% CI 1.4-3.8, P = 0.001). Hormonal contraception was not associated with an increased risk of infection with Neisseria gonorrhoeae.

CONCLUSION:

The use of hormonal contraception by HIV-1-infected women was associated with an increased risk of cervicitis and cervical chlamydia infection. HIV-1-seropositive women using hormonal contraception should be counseled about the importance of consistent condom use to prevent both STI and HIV-1 transmission.

• Authors: Ludo Lavreys, Varsha Chohan, Julie Overbaugh, Wisal Hassan, R Scott McClelland, Joan Kreiss, Kishorchandra Mandaliya, Jeckoniah Ndinya-Achola, Jared M Baeten
• Journal: AIDS (London, England) (AIDS) Vol. 18 Issue 16 Pg. 2179-84 (Nov 05 2004) ISSN: 0269-9370 [Print] England
• PMID: 15577651 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Contraceptives, Oral, Hormonal
• Medroxyprogesterone Acetate

Topics

• Adult
• Chlamydia Infections (transmission)
• Contraceptives, Oral, Hormonal (administration & dosage)
• Developing Countries
• Female
• Follow-Up Studies
• HIV Seropositivity
• HIV-1
• Humans
• Injections, Intravenous
• Kenya
• Medroxyprogesterone Acetate (administration & dosage)
• Proportional Hazards Models
• Prospective Studies
• Risk
• Sex Work
• Sexually Transmitted Diseases (transmission)
• Uterine Cervicitis (etiology)