Hormonal Contraception and Metabolic Outcomes in Women With or at Risk for HIV Infection

Abstract

Introduction 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 HDL, LDL, 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 to non-HC users, progestin-only HC was independently associated with lower HDL (-3mg/dL;95% confidence interval[CI]:-5,-1 in HIV-infected and -6mg/dL;95% CI:-9,-3 in HIV-uninfected women), greater HOMA (+0.86;95% CI:0.51,1.22 and +0.56;95% CI:0.12,1.01). Combined HC was associated with higher HDL(+5mg/dL;95% CI:2,7 and +5mg/dL;95% CI:3,7). Conclusion Progestin–only HC is associated with lower HDL and greater HOMA-IR than 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.

Contraception in HIV-positive female adolescents

“…The issue has been studied by Womack et al [62] who enrolled HIV-infected and uninfected women in the Women's Interagency HIV Study (WIHS), an ongoing multicenter longitudinal cohort study of the progression of HIV infection in women. The authors found that progestin-only and combined HC impact metabolic outcomes differently.…”

Hormonal Contraception and Risk of Psychiatric and Other Noncommunicable Diseases in HIV-Infected Women

“…Results of that study demonstrated the complexity of hormonal contraception effects: progestin-only hormonal contraception use was associated with slightly lower highdensity lipoprotein and higher risk of insulin resistance, while use of combined forms of hormonal contraception was associated with increased high-density lipoprotein and was not associated with insulin resistance in both HIV-infected and HIV-uninfected women. 66 With few outcomes, we were limited to investigate differences in risk of specific NCDs by hormonal contraception exposure history.…”