MONTREAL, Feb. 12 — Hormonal contraceptives do not speed the progression of HIV disease, researchers found.

• Explain to interested patients that some studies have found suggestions that hormonal methods of contraception may speed up the progression of HIV.
• Note that this study, conducted in nine countries in Africa and Asia, showed no effect of the contraceptives on HIV progression.
• Note, too, that this study was published as an abstract and presented orally at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

The “encouraging” finding is important for most of the 15 million women worldwide who have HIV and are of child-bearing age, according to Elizabeth Stringer, M.D., of the University of Alabama.

“Our study shows these drugs are safe for women with HIV infection,” Dr. Stringer said at the Conference on Retroviruses and Opportunistic Infections here.

Although the study took place in the developing world, it should be reassuring for all women with HIV, she said.

The issue arose, Dr. Stringer said, because some animal and human studies had suggested that hormonal contraception speeded the progression of HIV. But the findings were incidental observations in studies aimed at other issues, she said.

To clarify the matter, she and her colleagues analyzed outcomes in 4,350 HIV-positive women who were not on antiretroviral therapy and were not pregnant in nine developing countries in Africa and Asia.

The participants, part of a larger trial investigating mother-to-child transmission, were followed from 2003 to 2008, Dr. Stringer said. Disease progression in the study was defined as death or becoming eligible for highly active antiretroviral therapy (HAART).

The women in the study were stratified according to what form of contraception they used — 830 used progesterone-based injectable or implant methods and 230 used progesterone-estrogen oral contraceptives, while the vast majority (3,099) used nonhormonal methods or no contraception.

The latter group was used as a reference to calculate multivariate hazard ratios for death or eligibility for treatment. Compared with the reference group:

• Those on a progesterone contraception had an adjusted hazard ratio of 1.0 for disease progression, with a 95% confidence interval from 0.8 to 1.2.
• Women on oral progesterone-estrogen contraception had a hazard ratio of 0.9 for disease progression, with a 95% confidence interval from 0.6 to 1.2.
• When the risk was considered on a time-varying basis, the corresponding hazard ratios were 0.9 and 0.8, and both confidence intervals crossed unity.

Factors that did increase the risk of disease progression included a CD4 count of between 200 and 350 cells per cubic millimeter (all participants started above 200) and disease at WHO stages II and III.

Dr. Stringer said the study’s strengths include its large, multicountry cohort, with a diversity of patients and contraceptive methods.

On the other hand, she said, contraceptive exposure was based on self-report, the data is observational, and there is a potential for self-selection bias.

“Women with HIV, like any women, have to be given options for family planning,” said Wafaa El-Sadr, M.D., of New York’s Columbia University, who chaired a press conference at which the research was discussed.

“The concern has been that some (healthcare) providers were reluctant to prescribe hormonal contraception to women with HIV,” she said. “So this is very reassuring data.”

Primary source: Conference on Retroviruses and Opportunistic Infections

Source reference:
Stringer S, et al “Effect of hormonal contraception on HIV disease progression: A multi-country cohort analysis” CROI 2009; Abstract 175.

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