Castilho Jessica L, Jenkins Cathy A, Shepherd Bryan E, Bebawy Sally S, Turner Megan, Sterling Timothy R, Melekhin Vlada V
1 Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine , Nashville, Tennessee.
2 Department of Biostatistics, Vanderbilt University School of Medicine , Nashville, Tennessee.
J Womens Health (Larchmt). 2015 Jun;24(6):481-8. doi: 10.1089/jwh.2014.5003. Epub 2015 Mar 9.
Hormonal contraception use is common among human immunodeficiency virus (HIV)-infected women. Risk of psychiatric and other noninfectious complications of hormonal contraception use has not been described in this population.
We performed a retrospective cohort study of HIV-infected women receiving care in Tennessee from 1998 to 2008 to examine the risks of incident psychiatric and other noncommunicable diseases (NCDs), including cardiovascular, hepatic, renal, and malignant diseases, and hormonal contraception use, including depot medroxyprogesterone acetate (DMPA) and combined estrogen- and progestin-containing hormonal contraceptives. We used marginal structural models with inverse probability weights to account for time-varying confounders associated with hormonal contraception use.
Of the 392 women included, 94 (24%) used hormonal contraception during the study period. Baseline psychiatric disease was similar between women who received and did not receive hormonal contraception. There were 69 incident psychiatric diagnoses and 72 NCDs. Only time-varying DMPA use was associated with increased risk of psychiatric disease (adjusted odds ratio [aOR] 3.70; 95% confidence interval [95% CI] 1.32-10.4) and mood disorders, specifically (aOR 4.70 [1.87-11.8]). Time-varying and cumulative combined hormonal contraception use were not statistically associated with other NCDs (aOR 1.64, 95% CI 0.64-4.12 and aOR 1.16, 95% CI 0.86-1.56, respectively). However, risk of incident NCDs was increased with cumulative DMPA exposure (per year exposure aOR 1.45, 95% CI 1.01-2.08).
Among HIV-infected women, DMPA was associated with risk of incident psychiatric diseases, particularly mood disorders, during periods of use. Cumulative DMPA exposure was also associated with risk of other NCDs. However, combined estrogen and progestin-containing hormonal contraception use was not statistically associated with risk of any NCDs.
激素避孕在感染人类免疫缺陷病毒（HIV）的女性中很常见。该人群中使用激素避孕导致精神疾病和其他非感染性并发症的风险尚未有相关描述。
我们对1998年至2008年在田纳西州接受治疗的感染HIV的女性进行了一项回顾性队列研究，以检查新发精神疾病和其他非传染性疾病（NCDs）的风险，包括心血管疾病、肝脏疾病、肾脏疾病和恶性疾病，以及激素避孕的使用情况，包括醋酸甲羟孕酮长效注射剂（DMPA）和含雌激素和孕激素的复方激素避孕药。我们使用具有逆概率权重的边际结构模型来解释与激素避孕使用相关的随时间变化的混杂因素。
在纳入的392名女性中，94名（24%）在研究期间使用了激素避孕。接受和未接受激素避孕的女性基线精神疾病情况相似。有69例新发精神疾病诊断和72例非传染性疾病。仅随时间变化的DMPA使用与精神疾病风险增加相关（调整后的优势比[aOR]为3.70；95%置信区间[95%CI]为1.32 - 10.4），特别是与情绪障碍相关（aOR为4.70[1.87 - 11.8]）。随时间变化和累积使用复方激素避孕药与其他非传染性疾病无统计学关联（aOR分别为1.64，95%CI为0.64 - 4.12和aOR为1.16，95%CI为0.86 - 1.56）。然而，累积DMPA暴露会增加新发非传染性疾病的风险（每年暴露aOR为1.45，95%CI为1.01 - 2.08）。
在感染HIV的女性中，DMPA在使用期间与新发精神疾病风险相关，尤其是情绪障碍。累积DMPA暴露也与其他非传染性疾病风险相关。然而，使用含雌激素和孕激素的复方激素避孕药与任何非传染性疾病风险无统计学关联。
