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Effects of Depot Medroxyprogesterone Acetate, Copper Intrauterine Devices, and Levonorgestrel Implants on Early HIV Disease Progression.
AIDS Res Hum Retroviruses. 2020 08; 36(8):632-640.AR

Abstract

Limited data exist on the effects of contraceptives on HIV disease progression. We studied the association between intramuscular injectable depot medroxyprogesterone acetate (DMPA-IM), the copper intrauterine device (IUD), and the levonorgestrel (LNG) implant on markers of HIV disease progression at the time of HIV detection and 3 months postdetection and time from detection to CD4 count <350 cells/mm3. Among women initiating antiretroviral therapy (ART), we studied the effect of contraceptive group on time from ART initiation to viral load (VL) <40 copies/mL. We included women 16-35 years randomized to DMPA-IM, copper IUD, or LNG implant with incident HIV infection during the Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial (n = 382). We analyzed HIV VL and CD4 cell count according to participants' randomized method and also conducted a "continuous use" analysis that excluded follow-up time after method discontinuation. We used adjusted linear models to compare mean VL and CD4 cell levels by contraceptive group up to the time of ART initiation. We compared time from HIV detection to CD4 count <350 cells/mm3 and, following ART initiation, time to viral suppression (VL <40 copies/mL) using Cox proportional hazards models. At HIV detection, women allocated to DMPA-IM had lower VL relative to copper IUD (-0.28 log10 copies/mL; 95% confidence interval [CI]: -0.55 to -0.01) and LNG implant (-0.27, CI: -0.55 to 0.02) and higher mean CD4 than copper IUD users by 66 cells/mm3 (CI: 11-121). In continuous use analyses women allocated to DMPA-IM progressed to CD4 < 350 cells/mm3 slower than copper IUD users (hazard ratio [HR] = 0.6, CI: 0.3-1.1), whereas copper IUD users progressed faster than LNG implant users (HR = 1.8, CI: 1.0-3.3). Time to viral suppression was faster for DMPA-IM than copper IUD (HR = 1.5, CI: 1.0-2.3) and LNG implant 1.4 (CI: 0.9-2.2) users. We found no evidence of more rapid early HIV disease progression among women using DMPA-IM than among women using copper IUD or LNG implant. Our finding of more rapid progression among copper IUD compared with DMPA-IM users should be interpreted cautiously.

Authors+Show Affiliations

FHI 360, Durham, North Carolina, USA.Effective Care Research Unit, Department of Obstetrics and Gynaecology, University of Witwatersrand/Fort Hare/Walter Sisulu, East London, South Africa. Department of Obstetrics and Gynaecology, University of Botswana, Gaborone, Botswana.Department of Global Health, University of Washington, Seattle, USA.Wits Reproductive Health and HIV Institute (Wits RHI), University of Witswatersrand, Johannesburg, South Africa.Mailman School of Public Health, ICAP at Columbia University, New York, USA.Wits Reproductive Health and HIV Institute (Wits RHI), University of Witswatersrand, Johannesburg, South Africa.FHI 360, Durham, North Carolina, USA.Emavundleni Research Center, Capetown, South Africa.KEMRI-RCTP Study Center, Kisumu, Kenya.FHI 360, Durham, North Carolina, USA.Department of Global Health, University of Washington, Seattle, USA.Department of Global Health, University of Washington, Seattle, USA.The Aurum Institute, Johannesburg, South Africa. Department of Environmental Health Sciences, Yale School of Public Health, New Haven, Connecticut, USA. Faculty of Health Sciences, School of Pathology, University of the Witwatersrand, Johannesburg, South Africa.FHI 360, Durham, North Carolina, USA.MatCH Research Unit (MRU), Faculty of Health Sciences, Department of Obstetrics and Gynecology, University of the Witwatersrand, Durban, South Africa.MatCH Research Unit (MRU), Faculty of Health Sciences, Department of Obstetrics and Gynecology, University of the Witwatersrand, Durban, South Africa.Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.Department of Global Health, University of Washington, Seattle, USA.Setshaba Research Center, Soshanguve, South Africa.No affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32394723

Citation

Morrison, Charles S., et al. "Effects of Depot Medroxyprogesterone Acetate, Copper Intrauterine Devices, and Levonorgestrel Implants On Early HIV Disease Progression." AIDS Research and Human Retroviruses, vol. 36, no. 8, 2020, pp. 632-640.
Morrison CS, Hofmeyr GJ, Thomas KK, et al. Effects of Depot Medroxyprogesterone Acetate, Copper Intrauterine Devices, and Levonorgestrel Implants on Early HIV Disease Progression. AIDS Res Hum Retroviruses. 2020;36(8):632-640.
Morrison, C. S., Hofmeyr, G. J., Thomas, K. K., Rees, H., Philip, N., Palanee-Phillips, T., Nanda, K., Nair, G., Onono, M., Mastro, T. D., Lind, M., Heffron, R., Edward, V., Deese, J., Beksinska, M., Beesham, I., Stringer, J. S. A., Baeten, J. M., & Ahmed, K. (2020). Effects of Depot Medroxyprogesterone Acetate, Copper Intrauterine Devices, and Levonorgestrel Implants on Early HIV Disease Progression. AIDS Research and Human Retroviruses, 36(8), 632-640. https://doi.org/10.1089/AID.2020.0015
Morrison CS, et al. Effects of Depot Medroxyprogesterone Acetate, Copper Intrauterine Devices, and Levonorgestrel Implants On Early HIV Disease Progression. AIDS Res Hum Retroviruses. 2020;36(8):632-640. PubMed PMID: 32394723.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of Depot Medroxyprogesterone Acetate, Copper Intrauterine Devices, and Levonorgestrel Implants on Early HIV Disease Progression. AU - Morrison,Charles S, AU - Hofmeyr,G Justus, AU - Thomas,Katherine K, AU - Rees,Helen, AU - Philip,Neena, AU - Palanee-Phillips,Thesla, AU - Nanda,Kavita, AU - Nair,Gonasagrie, AU - Onono,Maricianah, AU - Mastro,Timothy D, AU - Lind,Maggie, AU - Heffron,Renee, AU - Edward,Vinodh, AU - Deese,Jen, AU - Beksinska,Mags, AU - Beesham,Ivana, AU - Stringer,Jeffrey S A, AU - Baeten,Jared M, AU - Ahmed,Khatija, AU - ,, Y1 - 2020/06/02/ PY - 2020/5/13/pubmed PY - 2020/5/13/medline PY - 2020/5/13/entrez KW - DMPA KW - HIV KW - disease progression KW - hormonal contraception KW - implants KW - intrauterine device KW - viral suppression SP - 632 EP - 640 JF - AIDS research and human retroviruses JO - AIDS Res Hum Retroviruses VL - 36 IS - 8 N2 - Limited data exist on the effects of contraceptives on HIV disease progression. We studied the association between intramuscular injectable depot medroxyprogesterone acetate (DMPA-IM), the copper intrauterine device (IUD), and the levonorgestrel (LNG) implant on markers of HIV disease progression at the time of HIV detection and 3 months postdetection and time from detection to CD4 count <350 cells/mm3. Among women initiating antiretroviral therapy (ART), we studied the effect of contraceptive group on time from ART initiation to viral load (VL) <40 copies/mL. We included women 16-35 years randomized to DMPA-IM, copper IUD, or LNG implant with incident HIV infection during the Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial (n = 382). We analyzed HIV VL and CD4 cell count according to participants' randomized method and also conducted a "continuous use" analysis that excluded follow-up time after method discontinuation. We used adjusted linear models to compare mean VL and CD4 cell levels by contraceptive group up to the time of ART initiation. We compared time from HIV detection to CD4 count <350 cells/mm3 and, following ART initiation, time to viral suppression (VL <40 copies/mL) using Cox proportional hazards models. At HIV detection, women allocated to DMPA-IM had lower VL relative to copper IUD (-0.28 log10 copies/mL; 95% confidence interval [CI]: -0.55 to -0.01) and LNG implant (-0.27, CI: -0.55 to 0.02) and higher mean CD4 than copper IUD users by 66 cells/mm3 (CI: 11-121). In continuous use analyses women allocated to DMPA-IM progressed to CD4 < 350 cells/mm3 slower than copper IUD users (hazard ratio [HR] = 0.6, CI: 0.3-1.1), whereas copper IUD users progressed faster than LNG implant users (HR = 1.8, CI: 1.0-3.3). Time to viral suppression was faster for DMPA-IM than copper IUD (HR = 1.5, CI: 1.0-2.3) and LNG implant 1.4 (CI: 0.9-2.2) users. We found no evidence of more rapid early HIV disease progression among women using DMPA-IM than among women using copper IUD or LNG implant. Our finding of more rapid progression among copper IUD compared with DMPA-IM users should be interpreted cautiously. SN - 1931-8405 UR - https://www.unboundmedicine.com/medline/citation/32394723/Effects_of_Depot_Medroxyprogesterone_Acetate_Copper_Intrauterine_Devices_and_Levonorgestrel_Implants_on_Early_HIV_Disease_Progression_ L2 - https://www.liebertpub.com/doi/10.1089/AID.2020.0015?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -
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