Hormonal Contraception, Pregnancy, Breastfeeding, and Risk of HIV Disease Progression Among Zambian Women
Identifieur interne : 000F92 ( Main/Exploration ); précédent : 000F91; suivant : 000F93Hormonal Contraception, Pregnancy, Breastfeeding, and Risk of HIV Disease Progression Among Zambian Women
Auteurs : Kristin M. Wall [États-Unis] ; William Kilembe [États-Unis] ; Lisa Haddad [États-Unis] ; Bellington Vwalika [États-Unis, Zambie] ; Shabir Lakhi [États-Unis, Zambie] ; Naw Htee Khu [États-Unis] ; Ilene Brill [États-Unis] ; Elwyn Chomba [États-Unis, Zambie] ; Joseph Mulenga [États-Unis] ; Amanda Tichacek [États-Unis] ; Susan Allen [États-Unis]Source :
- Journal of Acquired Immune Deficiency Syndromes (1999) [ 1525-4135 ] ; 2016.
Abstract
Some studies suggest that hormonal contraception, pregnancy, and/or breastfeeding may influence rates of HIV disease progression.
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.
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).
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.
Url:
DOI: 10.1097/QAI.0000000000000848
PubMed: 26379070
PubMed Central: 4752415
Affiliations:
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Wall</name><affiliation wicri:level="2"><nlm:aff id="aff1">Department of Pathology and Laboratory Medicine, Rwanda, Zambia HIV Research Group, School of Medicine, Atlanta, GA;</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName><wicri:cityArea>Department of Pathology and Laboratory Medicine, Rwanda, Zambia HIV Research Group, School of Medicine, Atlanta</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:aff id="aff2">Hubert, Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA;</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName><wicri:cityArea>Hubert, Department of Global Health, Rollins School of Public Health, Emory University, Atlanta</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:aff id="aff3">Department of Epidemiology, Rollins School of Public Health, Laney Graduate 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and Internal Medicine, School of Medicine, University of Zambia, Lusaka</wicri:regionArea><wicri:noRegion>Lusaka</wicri:noRegion></affiliation></author><author><name sortKey="Khu, Naw Htee" sort="Khu, Naw Htee" uniqKey="Khu N" first="Naw Htee" last="Khu">Naw Htee Khu</name><affiliation wicri:level="2"><nlm:aff id="aff1">Department of Pathology and Laboratory Medicine, Rwanda, Zambia HIV Research Group, School of Medicine, Atlanta, GA;</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName><wicri:cityArea>Department of Pathology and Laboratory Medicine, Rwanda, Zambia HIV Research Group, School of Medicine, Atlanta</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:aff id="aff2">Hubert, Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA;</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName><wicri:cityArea>Hubert, Department of Global Health, Rollins School of Public Health, Emory University, Atlanta</wicri:cityArea></affiliation></author><author><name sortKey="Brill, Ilene" sort="Brill, Ilene" uniqKey="Brill I" first="Ilene" last="Brill">Ilene Brill</name><affiliation wicri:level="2"><nlm:aff id="aff1">Department of Pathology and Laboratory Medicine, Rwanda, Zambia HIV Research Group, School of Medicine, Atlanta, GA;</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName><wicri:cityArea>Department of Pathology and Laboratory Medicine, Rwanda, Zambia HIV Research Group, School of Medicine, Atlanta</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:aff id="aff2">Hubert, Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA;</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName><wicri:cityArea>Hubert, Department of Global Health, Rollins School of Public Health, Emory University, Atlanta</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:aff wicri:cut="; and" id="aff6">Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham, AL</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Alabama</region></placeName><wicri:cityArea>Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Birmingham</wicri:cityArea></affiliation></author><author><name sortKey="Chomba, Elwyn" sort="Chomba, Elwyn" uniqKey="Chomba E" first="Elwyn" last="Chomba">Elwyn Chomba</name><affiliation wicri:level="2"><nlm:aff id="aff1">Department of Pathology and Laboratory Medicine, Rwanda, Zambia HIV Research Group, School of Medicine, Atlanta, GA;</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName><wicri:cityArea>Department of Pathology and Laboratory Medicine, Rwanda, Zambia HIV Research Group, School of Medicine, Atlanta</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:aff id="aff2">Hubert, Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA;</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName><wicri:cityArea>Hubert, Department of Global Health, Rollins School of Public Health, Emory University, Atlanta</wicri:cityArea></affiliation><affiliation wicri:level="1"><nlm:aff id="aff7">Ministry of Community Development, Mother and Child Health, Lusaka, Zambia.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Zambie</country><wicri:regionArea>Ministry of Community Development, Mother and Child Health, Lusaka</wicri:regionArea><wicri:noRegion>Lusaka</wicri:noRegion></affiliation></author><author><name sortKey="Mulenga, Joseph" sort="Mulenga, Joseph" uniqKey="Mulenga J" first="Joseph" last="Mulenga">Joseph Mulenga</name><affiliation wicri:level="2"><nlm:aff id="aff1">Department of Pathology and Laboratory Medicine, Rwanda, Zambia HIV Research Group, School of Medicine, Atlanta, GA;</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName><wicri:cityArea>Department of Pathology and Laboratory Medicine, Rwanda, Zambia HIV Research Group, School of Medicine, Atlanta</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:aff id="aff2">Hubert, Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA;</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName><wicri:cityArea>Hubert, Department of Global Health, Rollins School of Public Health, Emory University, Atlanta</wicri:cityArea></affiliation></author><author><name sortKey="Tichacek, Amanda" sort="Tichacek, Amanda" uniqKey="Tichacek A" first="Amanda" last="Tichacek">Amanda Tichacek</name><affiliation wicri:level="2"><nlm:aff id="aff1">Department of Pathology and Laboratory Medicine, Rwanda, Zambia HIV Research Group, School of Medicine, Atlanta, GA;</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName><wicri:cityArea>Department of Pathology and Laboratory Medicine, Rwanda, Zambia HIV Research Group, School of Medicine, Atlanta</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:aff id="aff2">Hubert, Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA;</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName><wicri:cityArea>Hubert, Department of Global Health, Rollins School of Public Health, Emory University, Atlanta</wicri:cityArea></affiliation></author><author><name sortKey="Allen, Susan" sort="Allen, Susan" uniqKey="Allen S" first="Susan" last="Allen">Susan Allen</name><affiliation wicri:level="2"><nlm:aff id="aff1">Department of Pathology and Laboratory Medicine, Rwanda, Zambia HIV Research Group, School of Medicine, Atlanta, GA;</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName><wicri:cityArea>Department of Pathology and Laboratory Medicine, Rwanda, Zambia HIV Research Group, School of Medicine, Atlanta</wicri:cityArea></affiliation><affiliation wicri:level="2"><nlm:aff id="aff2">Hubert, Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA;</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Géorgie (États-Unis)</region></placeName><wicri:cityArea>Hubert, Department of Global Health, Rollins School of Public Health, Emory University, Atlanta</wicri:cityArea></affiliation></author></analytic><series><title level="j">Journal of Acquired Immune Deficiency Syndromes (1999)</title><idno type="ISSN">1525-4135</idno><idno type="eISSN">1944-7884</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background:</title><p>Some studies suggest that hormonal contraception, pregnancy, and/or breastfeeding may influence rates of HIV disease progression.</p></sec><sec><title>Methods:</title><p>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.</p></sec><sec><title>Results:</title><p>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).</p></sec><sec><title>Conclusions:</title><p>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.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Phillips, Sj" uniqKey="Phillips S">SJ Phillips</name></author><author><name sortKey="Curtis, Km" uniqKey="Curtis K">KM Curtis</name></author><author><name sortKey="Polis, Cb" uniqKey="Polis C">CB Polis</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Stringer, Em" uniqKey="Stringer E">EM Stringer</name></author><author><name sortKey="Levy, J" uniqKey="Levy J">J Levy</name></author><author><name sortKey="Sinkala, M" uniqKey="Sinkala M">M 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Karita</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Zambie</li><li>États-Unis</li></country><region><li>Alabama</li><li>Géorgie (États-Unis)</li></region></list><tree><country name="États-Unis"><region name="Géorgie (États-Unis)"><name sortKey="Wall, Kristin M" sort="Wall, Kristin M" uniqKey="Wall K" first="Kristin M." last="Wall">Kristin M. Wall</name></region><name sortKey="Allen, Susan" sort="Allen, Susan" uniqKey="Allen S" first="Susan" last="Allen">Susan Allen</name><name sortKey="Allen, Susan" sort="Allen, Susan" uniqKey="Allen S" first="Susan" last="Allen">Susan Allen</name><name sortKey="Brill, Ilene" sort="Brill, Ilene" uniqKey="Brill I" first="Ilene" last="Brill">Ilene Brill</name><name sortKey="Brill, Ilene" sort="Brill, Ilene" uniqKey="Brill I" first="Ilene" last="Brill">Ilene Brill</name><name sortKey="Brill, Ilene" sort="Brill, Ilene" uniqKey="Brill I" first="Ilene" last="Brill">Ilene Brill</name><name sortKey="Chomba, Elwyn" sort="Chomba, Elwyn" uniqKey="Chomba E" first="Elwyn" last="Chomba">Elwyn Chomba</name><name sortKey="Chomba, Elwyn" sort="Chomba, Elwyn" uniqKey="Chomba E" first="Elwyn" last="Chomba">Elwyn Chomba</name><name sortKey="Haddad, Lisa" sort="Haddad, Lisa" uniqKey="Haddad L" first="Lisa" last="Haddad">Lisa Haddad</name><name sortKey="Haddad, Lisa" sort="Haddad, Lisa" uniqKey="Haddad L" first="Lisa" last="Haddad">Lisa Haddad</name><name sortKey="Haddad, Lisa" sort="Haddad, Lisa" uniqKey="Haddad L" first="Lisa" last="Haddad">Lisa Haddad</name><name sortKey="Khu, Naw Htee" sort="Khu, Naw Htee" uniqKey="Khu N" first="Naw Htee" last="Khu">Naw Htee Khu</name><name sortKey="Khu, Naw Htee" sort="Khu, Naw Htee" uniqKey="Khu N" first="Naw Htee" last="Khu">Naw Htee Khu</name><name sortKey="Kilembe, William" sort="Kilembe, William" uniqKey="Kilembe W" first="William" last="Kilembe">William Kilembe</name><name sortKey="Lakhi, Shabir" sort="Lakhi, Shabir" uniqKey="Lakhi S" first="Shabir" last="Lakhi">Shabir Lakhi</name><name sortKey="Lakhi, Shabir" sort="Lakhi, Shabir" uniqKey="Lakhi S" first="Shabir" last="Lakhi">Shabir Lakhi</name><name sortKey="Mulenga, Joseph" sort="Mulenga, Joseph" uniqKey="Mulenga J" first="Joseph" last="Mulenga">Joseph Mulenga</name><name sortKey="Mulenga, Joseph" sort="Mulenga, Joseph" uniqKey="Mulenga J" first="Joseph" last="Mulenga">Joseph Mulenga</name><name sortKey="Tichacek, Amanda" sort="Tichacek, Amanda" uniqKey="Tichacek A" first="Amanda" last="Tichacek">Amanda Tichacek</name><name sortKey="Tichacek, Amanda" sort="Tichacek, Amanda" uniqKey="Tichacek A" first="Amanda" last="Tichacek">Amanda Tichacek</name><name sortKey="Vwalika, Bellington" sort="Vwalika, Bellington" uniqKey="Vwalika B" first="Bellington" last="Vwalika">Bellington Vwalika</name><name sortKey="Vwalika, Bellington" sort="Vwalika, Bellington" uniqKey="Vwalika B" first="Bellington" last="Vwalika">Bellington Vwalika</name><name sortKey="Wall, Kristin M" sort="Wall, Kristin M" uniqKey="Wall K" first="Kristin M." last="Wall">Kristin M. Wall</name><name sortKey="Wall, Kristin M" sort="Wall, Kristin M" uniqKey="Wall K" first="Kristin M." last="Wall">Kristin M. Wall</name></country><country name="Zambie"><noRegion><name sortKey="Vwalika, Bellington" sort="Vwalika, Bellington" uniqKey="Vwalika B" first="Bellington" last="Vwalika">Bellington Vwalika</name></noRegion><name sortKey="Chomba, Elwyn" sort="Chomba, Elwyn" uniqKey="Chomba E" first="Elwyn" last="Chomba">Elwyn Chomba</name><name sortKey="Lakhi, Shabir" sort="Lakhi, Shabir" uniqKey="Lakhi S" first="Shabir" last="Lakhi">Shabir Lakhi</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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