Morrison Charles S, Hofmeyr G Justus, Thomas Katherine K, Rees Helen, Philip Neena, Palanee-Phillips Thesla, Nanda Kavita, Nair Gonasagrie, Onono Maricianah, Mastro Timothy D, Lind Maggie, Heffron Renee, Edward Vinodh, Deese Jen, Beksinska Mags, Beesham Ivana, Stringer Jeffrey S A, Baeten Jared M, Ahmed Khatija
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.
AIDS Res Hum Retroviruses. 2020 Aug;36(8):632-640. doi: 10.1089/AID.2020.0015. Epub 2020 Jun 2.
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/mm. 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 ( = 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/mm 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 log 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/mm (CI: 11-121). In continuous use analyses women allocated to DMPA-IM progressed to CD4 < 350 cells/mm 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.
关于避孕药对艾滋病毒疾病进展的影响，现有数据有限。我们研究了肌内注射醋酸甲羟孕酮长效避孕针（DMPA-IM）、铜宫内节育器（IUD）和左炔诺孕酮（LNG）植入剂与艾滋病毒检测时、检测后3个月以及从检测到CD4细胞计数<350个细胞/mm³的时间点上艾滋病毒疾病进展标志物之间的关联。在开始抗逆转录病毒治疗（ART）的女性中，我们研究了避孕方法分组对从开始ART到病毒载量（VL）<40拷贝/mL所需时间的影响。我们纳入了年龄在16至35岁之间、在避孕选择与艾滋病毒结局证据（ECHO）试验期间随机分配接受DMPA-IM、铜IUD或LNG植入剂且新发艾滋病毒感染的女性（n = 382）。我们根据参与者的随机分组方法分析了艾滋病毒VL和CD4细胞计数，并进行了一项“持续使用”分析，排除了方法停用后的随访时间。我们使用校正线性模型比较了各避孕组在开始ART之前的平均VL和CD4细胞水平。我们使用Cox比例风险模型比较了从艾滋病毒检测到CD4细胞计数<350个细胞/mm³的时间，以及开始ART后达到病毒抑制（VL<40拷贝/mL）的时间。在艾滋病毒检测时，分配到DMPA-IM组的女性相对于铜IUD组（-0.28 log拷贝/mL；95%置信区间[CI]：-0.55至-0.01）和LNG植入剂组（-0.27，CI：-0.55至0.02）的VL较低，且平均CD4细胞数比铜IUD使用者高66个细胞/mm³（CI：11 - 121）。在持续使用分析中，分配到DMPA-IM组的女性进展到CD4<350个细胞/mm³的速度比铜IUD使用者慢（风险比[HR]=0.6，CI：0.3 - 1.1），而铜IUD使用者进展速度比LNG植入剂使用者快（HR = 1.8，CI：1.0 - 3.3）。DMPA-IM组达到病毒抑制所需的时间比铜IUD组（HR = 1.5，CI：1.0 - 2.3）和LNG植入剂组（HR = 1.4，CI：0.9 - 2.2）使用者更快。我们没有发现使用DMPA-IM的女性比使用铜IUD或LNG植入剂的女性艾滋病毒疾病早期进展更快的证据。我们关于铜IUD使用者与DMPA-IM使用者相比进展更快的发现应谨慎解读。
