Hormonal contraception and metabolic outcomes in women with or at risk for HIV infection

Julie A. Womack, Rebecca Scherzer, Stephen R. Cole, Kristopher Fennie, Ann B. Williams, Margaret Grey, Howard Minkoff, Kathryn Anastos, Mardge H. Cohen, Phyllis C. Tien

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

OBJECTIVE: The use of hormonal contraception (HC) is increasing in HIV-infected women. Both HC and HIV infection have been associated with adverse metabolic outcomes. We investigated the association of progestin-only and combined (estrogen/progestin) HC with disorders of glucose and lipid metabolism in HIV-infected and uninfected women. METHODS: Linear mixed models evaluated the association of HC type with fasting high density lipoprotein, low density lipoprotein, triglycerides, the homeostasis model assessment estimate of insulin resistance (HOMA-IR), and glucose in 885 HIV-infected and 408 HIV-uninfected women from the Women's Interagency HIV Study seen between October 2000 and September 2005. RESULTS: Compared with non-HC users, progestin-only HC was independently associated with lower HDL [-3 mg/dL; 95% confidence interval (CI) -5, -1 in HIV-infected and -6 mg/dL; 95% CI: -9, -3 in HIV-uninfected women] and greater HOMA-IR (+0.86; 95% CI: 0.51-1.22 and +0.56; 95% CI: 0.12-1.01). Combined HC was associated with higher HDL (+5 mg/dL; 95% CI: 2-7 and +5 mg/dL; 95% CI: 3-7). CONCLUSIONS: HIV-infected women using progestin-only HC have lower HDL and greater HOMA-IR than HIV-infected non-HC users. Combined HC may be preferred in HIV-infected women of reproductive age at risk for cardiovascular disease, but interactions with antiretroviral therapy that may impair contraceptive efficacy have been reported. Alternative HC methods that minimize adverse outcomes but maintain efficacy require further study.

Original languageEnglish (US)
Pages (from-to)581-587
Number of pages7
JournalJournal of Acquired Immune Deficiency Syndromes
Volume52
Issue number5
DOIs
StatePublished - Dec 1 2009

Keywords

  • Depo Provera
  • HDL
  • HIV/AIDS
  • Hormonal contraception
  • Triglycerides

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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    Womack, J. A., Scherzer, R., Cole, S. R., Fennie, K., Williams, A. B., Grey, M., Minkoff, H., Anastos, K., Cohen, M. H., & Tien, P. C. (2009). Hormonal contraception and metabolic outcomes in women with or at risk for HIV infection. Journal of Acquired Immune Deficiency Syndromes, 52(5), 581-587. https://doi.org/10.1097/QAI.0b013e3181b9e5ee