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American Journal of Epidemiology 2005 161(9):881-890; doi:10.1093/aje/kwi116
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American Journal of Epidemiology Copyright © 2005 by the Johns Hopkins Bloomberg School of Public Health All rights reserved

ORIGINAL CONTRIBUTIONS

Hormonal Contraceptive Use and the Effectiveness of Highly Active Antiretroviral Therapy

Jaclyn H. Chu1, Stephen J. Gange1, Kathryn Anastos2, Howard Minkoff3, Helen Cejtin4, Melanie Bacon5, Alexandra Levine6 and Ruth M. Greenblatt7

1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
2 Montefiore Medical Center, New York, NY
3 Department of Obstetrics and Gynecology, Maimonides Medical Center and SUNY Health Sciences Center at Brooklyn, New York, NY
4 Cook County Hospital, Chicago, IL
5 Georgetown University Medical Center, Washington, DC
6 Keck School of Medicine, University of Southern California, Los Angeles, CA
7 Departments of Medicine and Epidemiology, University of California at San Francisco, San Francisco, CA

Reprint requests to Dr. Stephen J. Gange, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Room E-7638, Baltimore, MD 21205 (e-mail: sgange{at}jhsph.edu).

The role of hormonal contraceptive use in the effectiveness of highly active antiretroviral therapy (HAART) was examined among participants in the Women's Interagency HIV Study who were followed from HAART initiation to 2001. Propensity score selection was used to match 77 hormonal contraceptive users with 77 nonusers on age, race, and pre-HAART CD4-positive T-lymphocyte (CD4+ cell) count and viral load. The authors compared hormonal contraceptive users and nonusers with regard to the CD4+ cell count and viral load responses to HAART upon initiation. Proportional hazards analyses were used to assess the effect of hormonal contraceptive use on times to increases in CD4+ cell count of 50 cells/mm3 and 100 cells/mm3 and achievement of an undetectable viral load. There were no statistically significant differences in CD4+ cell counts and log viral load responses by hormone use after HAART initiation, except in log viral load at the third visit after initiation (p = 0.047). Time-dependent hormonal contraceptive use was not a statistically significant predictor of achieving increases in CD4+ cell count of 50 cells/mm3 and 100 cells/mm3 or an undetectable viral load (p = 0.517, p = 0.751, and p = 0.218, respectively) after HAART initiation. In conclusion, the authors did not find substantial evidence that use of hormonal contraceptives strongly affected responses to HAART.

antiretroviral therapy, highly active; contraceptives, oral, hormonal; HIV; hormones; levonorgestrel; medroxyprogesterone 17-acetate

Abbreviations: HAART, highly active antiretroviral therapy; HIV, human immunodeficiency virus; NNRTI, nonnucleoside reverse transcriptase inhibitor; NRTI, nucleoside reverse transcriptase inhibitor; WIHS, Women's Interagency HIV Study


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