Heffron Renee, Muwonge Timothy R, Thomas Katherine K, Zewdie Kidist, Ssebuliba Timothy, Stein Gabrielle, Morrison Susan, Badaru Josephine, Nakyanzi Agnes, Bambia Felix, Mugwanya Kenneth, Wyatt Christina, Matovu Flavia, Yin Michael T, Mujugira Andrew
Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
Department of Global Health, University of Washington, Seattle, WA, USA.
AIDS. 2025 Feb 1;39(2):123-132. doi: 10.1097/QAD.0000000000004029. Epub 2024 Oct 8.
Injectable depot medroxyprogesterone acetate (DMPA) is the most common contraceptive choice among young women in Uganda, where HIV burden is high and HIV preexposure prophylaxis (PrEP) may be offered. For young women who choose to use both agents concurrently, it is unknown whether they will experience declines in bone mineral density (BMD) beyond those elicited by either product singly.
From 2018 to 2022, we conducted a 2-year prospective study with women ages 16-25 years in Kampala, Uganda desiring pregnancy and HIV prevention. Women were provided condoms, injectable DMPA, and/or FTC/TDF, according to their choices and underwent annual dual X-ray absorptiometry (DXA) scans. We used tenofovir-diphosphate (TFV-DP) quantification in dried blood spots and DMPA injection dates to classify exposure. Linear regression models estimated the difference in percent BMD change from baseline to month 12 for women using FTC/TDF and DMPA versus women using neither product.
Of 499 enrolled women, discontinuation and re-starting of contraception and PrEP was common. Women consistently using neither product ( n = 39) experienced BMD increases. Women with consistent use of both products during 1 year ( n = 22) experienced an average BMD loss of 1.04% at lumbar spine and hip and 1.77% at femoral neck. These losses were different relative to women who used neither agent: lumbar spine -3.35% (95% CI -5.13 to -1.56%, P = 0.001), total hip -2.24% (95% CI -3.87 to -0.60%, P = 0.009), and femoral neck -1.71% (95% CI -3.73 to 0.31%, P = 0.102).
We observed a trend for women with concurrent DMPA and FTC/TDF PrEP use to have 1-3% lower BMD than unexposed women after 12 months.
注射用长效醋酸甲羟孕酮（DMPA）是乌干达年轻女性中最常用的避孕选择，该国艾滋病毒负担较高，可能会提供艾滋病毒暴露前预防（PrEP）。对于选择同时使用这两种药物的年轻女性来说，她们的骨密度（BMD）下降幅度是否会超过单独使用任何一种产品所引起的下降幅度尚不清楚。
2018年至2022年，我们在乌干达坎帕拉对16 - 25岁希望预防怀孕和感染艾滋病毒的女性进行了一项为期2年的前瞻性研究。根据女性的选择，为她们提供避孕套、注射用DMPA和/或替诺福韦酯/恩曲他滨（FTC/TDF），并每年进行双能X线吸收测定（DXA）扫描。我们通过检测干血斑中的二磷酸替诺福韦（TFV-DP）含量和DMPA注射日期来分类暴露情况。线性回归模型估计了使用FTC/TDF和DMPA的女性与两种产品都不使用的女性从基线到第12个月骨密度变化百分比的差异。
在499名登记入组的女性中，停用和重新开始避孕及PrEP的情况很常见。两种产品都不持续使用的女性（n = 39）骨密度增加。在1年中持续同时使用两种产品的女性（n = 22），腰椎、髋部的骨密度平均损失1.04%，股骨颈骨密度平均损失1.77%。与两种产品都不使用的女性相比，这些损失有所不同：腰椎为-3.35%（95%CI -5.13至-1.56%，P = 0.001），全髋为-2.24%（95%CI -3.87至-0.60%，P = 0.009），股骨颈为-1.71%（95%CI -3.73至0.31%，P = 0.102）。
我们观察到，同时使用DMPA和FTC/TDF进行PrEP的女性在12个月后骨密度比未暴露女性低1% - 3%的趋势。
