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 Citations (Scopus)

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 2009

Fingerprint

Contraception
HIV Infections
HIV
Progestins
Confidence Intervals
Insulin Resistance
Homeostasis
Glucose Metabolism Disorders
Lipid Metabolism Disorders
HDL3 Lipoprotein
HDL Lipoproteins
Contraceptive Agents
HIV-1
Linear Models
Fasting
Estrogens
Cardiovascular Diseases
Glucose

Keywords

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

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)
  • Medicine(all)

Cite this

Womack, J. A., Scherzer, R., Cole, S. R., Fennie, K., Williams, A. B., Grey, M., ... 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

Hormonal contraception and metabolic outcomes in women with or at risk for HIV infection. / Womack, Julie A.; Scherzer, Rebecca; Cole, Stephen R.; Fennie, Kristopher; Williams, Ann B.; Grey, Margaret; Minkoff, Howard; Anastos, Kathryn; Cohen, Mardge H.; Tien, Phyllis C.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 52, No. 5, 12.2009, p. 581-587.

Research output: Contribution to journalArticle

Womack, JA, Scherzer, R, Cole, SR, Fennie, K, Williams, AB, Grey, M, Minkoff, H, Anastos, K, Cohen, MH & Tien, PC 2009, 'Hormonal contraception and metabolic outcomes in women with or at risk for HIV infection', Journal of Acquired Immune Deficiency Syndromes, vol. 52, no. 5, pp. 581-587. https://doi.org/10.1097/QAI.0b013e3181b9e5ee
Womack, Julie A. ; Scherzer, Rebecca ; Cole, Stephen R. ; Fennie, Kristopher ; Williams, Ann B. ; Grey, Margaret ; Minkoff, Howard ; Anastos, Kathryn ; Cohen, Mardge H. ; Tien, Phyllis C. / Hormonal contraception and metabolic outcomes in women with or at risk for HIV infection. In: Journal of Acquired Immune Deficiency Syndromes. 2009 ; Vol. 52, No. 5. pp. 581-587.
@article{98a624c1cfed4d1fa2fc7ed07556f4fb,
title = "Hormonal contraception and metabolic outcomes in women with or at risk for HIV infection",
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.",
keywords = "Depo Provera, HDL, HIV/AIDS, Hormonal contraception, Triglycerides",
author = "Womack, {Julie A.} and Rebecca Scherzer and Cole, {Stephen R.} and Kristopher Fennie and Williams, {Ann B.} and Margaret Grey and Howard Minkoff and Kathryn Anastos and Cohen, {Mardge H.} and Tien, {Phyllis C.}",
year = "2009",
month = "12",
doi = "10.1097/QAI.0b013e3181b9e5ee",
language = "English (US)",
volume = "52",
pages = "581--587",
journal = "Journal of Acquired Immune Deficiency Syndromes",
issn = "1525-4135",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Hormonal contraception and metabolic outcomes in women with or at risk for HIV infection

AU - Womack, Julie A.

AU - Scherzer, Rebecca

AU - Cole, Stephen R.

AU - Fennie, Kristopher

AU - Williams, Ann B.

AU - Grey, Margaret

AU - Minkoff, Howard

AU - Anastos, Kathryn

AU - Cohen, Mardge H.

AU - Tien, Phyllis C.

PY - 2009/12

Y1 - 2009/12

N2 - 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.

AB - 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.

KW - Depo Provera

KW - HDL

KW - HIV/AIDS

KW - Hormonal contraception

KW - Triglycerides

UR - http://www.scopus.com/inward/record.url?scp=73349098769&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=73349098769&partnerID=8YFLogxK

U2 - 10.1097/QAI.0b013e3181b9e5ee

DO - 10.1097/QAI.0b013e3181b9e5ee

M3 - Article

VL - 52

SP - 581

EP - 587

JO - Journal of Acquired Immune Deficiency Syndromes

JF - Journal of Acquired Immune Deficiency Syndromes

SN - 1525-4135

IS - 5

ER -