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Charles S Morrison - One of the best experts on this subject based on the ideXlab platform.
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Hormonal Contraception and the risk of HIV acquisition: an individual participant data meta-analysis.
Public Library of Science (PLoS), 2015Co-Authors: Charles S Morrison, Jared M Baeten, Cynthia Kwok, Pailien Chen, Joelle Brown, Angela M Crook, Lut Van Damme, Sinead Delany-moretlwe, Suzanna C Francis, Barbara A FriedlandAbstract:Observational studies of a putative association between Hormonal Contraception (HC) and HIV acquisition have produced conflicting results. We conducted an individual participant data (IPD) meta-analysis of studies from sub-Saharan Africa to compare the incidence of HIV infection in women using combined oral contraceptives (COCs) or the injectable progestins depot-medroxyprogesterone acetate (DMPA) or norethisterone enanthate (NET-EN) with women not using HC.Eligible studies measured HC exposure and incident HIV infection prospectively using standardized measures, enrolled women aged 15-49 y, recorded ≥15 incident HIV infections, and measured prespecified covariates. Our primary analysis estimated the adjusted hazard ratio (aHR) using two-stage random effects meta-analysis, controlling for region, marital status, age, number of sex partners, and condom use. We included 18 studies, including 37,124 women (43,613 woman-years) and 1,830 incident HIV infections. Relative to no HC use, the aHR for HIV acquisition was 1.50 (95% CI 1.24-1.83) for DMPA use, 1.24 (95% CI 0.84-1.82) for NET-EN use, and 1.03 (95% CI 0.88-1.20) for COC use. Between-study heterogeneity was mild (I(2) < 50%). DMPA use was associated with increased HIV acquisition compared with COC use (aHR 1.43, 95% CI 1.23-1.67) and NET-EN use (aHR 1.32, 95% CI 1.08-1.61). Effect estimates were attenuated for studies at lower risk of methodological bias (compared with no HC use, aHR for DMPA use 1.22, 95% CI 0.99-1.50; for NET-EN use 0.67, 95% CI 0.47-0.96; and for COC use 0.91, 95% CI 0.73-1.41) compared to those at higher risk of bias (p(interaction) = 0.003). Neither age nor herpes simplex virus type 2 infection status modified the HC-HIV relationship.This IPD meta-analysis found no evidence that COC or NET-EN use increases women's risk of HIV but adds to the evidence that DMPA may increase HIV risk, underscoring the need for additional safe and effective contraceptive options for women at high HIV risk. A randomized controlled trial would provide more definitive evidence about the effects of Hormonal Contraception, particularly DMPA, on HIV risk
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Hormonal Contraception and the Risk of HIV Acquisition: An Individual Participant Data Meta-analysis
2015Co-Authors: Charles S Morrison, Jared M Baeten, Cynthia Kwok, Pailien Chen, Joelle Brown, Angela M Crook, Lut Van Damme, Sinead Delany-moretlwe, Suzanna C Francis, Barbara A FriedlandAbstract:BackgroundObservational studies of a putative association between Hormonal Contraception (HC) and HIV acquisition have produced conflicting results. We conducted an individual participant data (IPD) meta-analysis of studies from sub-Saharan Africa to compare the incidence of HIV infection in women using combined oral contraceptives (COCs) or the injectable progestins depot-medroxyprogesterone acetate (DMPA) or norethisterone enanthate (NET-EN) with women not using HC.Methods and FindingsEligible studies measured HC exposure and incident HIV infection prospectively using standardized measures, enrolled women aged 15–49 y, recorded ≥15 incident HIV infections, and measured prespecified covariates. Our primary analysis estimated the adjusted hazard ratio (aHR) using two-stage random effects meta-analysis, controlling for region, marital status, age, number of sex partners, and condom use. We included 18 studies, including 37,124 women (43,613 woman-years) and 1,830 incident HIV infections. Relative to no HC use, the aHR for HIV acquisition was 1.50 (95% CI 1.24–1.83) for DMPA use, 1.24 (95% CI 0.84–1.82) for NET-EN use, and 1.03 (95% CI 0.88–1.20) for COC use. Between-study heterogeneity was mild (I2 < 50%). DMPA use was associated with increased HIV acquisition compared with COC use (aHR 1.43, 95% CI 1.23–1.67) and NET-EN use (aHR 1.32, 95% CI 1.08–1.61). Effect estimates were attenuated for studies at lower risk of methodological bias (compared with no HC use, aHR for DMPA use 1.22, 95% CI 0.99–1.50; for NET-EN use 0.67, 95% CI 0.47–0.96; and for COC use 0.91, 95% CI 0.73–1.41) compared to those at higher risk of bias (pinteraction = 0.003). Neither age nor herpes simplex virus type 2 infection status modified the HC–HIV relationship.ConclusionsThis IPD meta-analysis found no evidence that COC or NET-EN use increases women’s risk of HIV but adds to the evidence that DMPA may increase HIV risk, underscoring the need for additional safe and effective contraceptive options for women at high HIV risk. A randomized controlled trial would provide more definitive evidence about the effects of Hormonal Contraception, particularly DMPA, on HIV risk.
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cervical inflammation and immunity associated with Hormonal Contraception pregnancy and hiv 1 seroconversion
Journal of Acquired Immune Deficiency Syndromes, 2014Co-Authors: Charles S Morrison, Cynthia Kwok, Pailien Chen, Raina N Fichorova, Chris Mauck, Tsungai Chipato, Robert A Salata, Gustavo F DoncelAbstract:OBJECTIVE: Hormonal Contraception (HC) younger age and pregnancy have been associated with increased HIV risk in some studies. We sought to elucidate the biological mechanisms for these associations. DESIGN: Case-control selection of specimens from a large prospective clinical study. METHODS: We enrolled and followed 4531 HIV-negative women from Uganda and Zimbabwe using either the injectable depo-medroxyprogesterone acetate (DMPA) combined oral Contraception or no HC (NH). Innate immunity mediators were measured in cervical samples collected from women at their visit before HIV seroconversion (n = 199) and matched visits from women remaining HIV uninfected (n = 633). Generalized linear models were applied after Box-Cox power transformation. RESULTS: Higher RANTES and lower secretory leukocyte protease inhibitor (SLPI) levels were associated with HIV seroconversion. DMPA users had higher RANTES and lower BD-2 levels. Most inflammation-promoting and/or inflammation-inducible mediators were higher [interleukin (IL)-1beta IL-6 IL-8 MIP-3alpha vascular endothelial growth factor and SLPI] and the protective BD-2 and IL-1RA:IL-1beta ratio were lower among combined oral Contraception users. Pregnant women showed a similar cervical immunity status (higher IL-1beta IL-6 IL-8 vascular endothelial growth factor SLPI and IL-1RA; lower IL-1RA:IL-1beta). Age <25 years was associated with lower SLPI IL-8 MIP-3alpha but higher IL-1RA:IL-1beta. Zimbabwean women (with higher HIV seroconversion rates) had overall higher pro-inflammatory and lower anti-inflammatory protein levels than Ugandan women. CONCLUSIONS: HC use pregnancy and young age alter cervical immunity in different ways known to increase risk of HIV for example through increased levels of pro-inflammatory cytokines or decreased levels of SLPI. Higher levels of RANTES may be one factor underlying a possible association between DMPA use and risk of HIV acquisition.
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Hormonal Contraception decreases bacterial vaginosis but oral Contraception may increase candidiasis implications for hiv transmission
AIDS, 2013Co-Authors: Marijn C Verwijs, Abigail Norris Turner, Charles S MorrisonAbstract:Objective A 2012 WHO consultation concluded that combined oral Contraception (COC) does not increase HIV acquisition in women, but the evidence for depot medroxyprogesterone acetate (DMPA) is conflicting. We evaluated the effect of COC and DMPA use on the vaginal microbiome because current evidence suggests that any deviation from a 'healthy' vaginal microbiome increases women's susceptibility to HIV. Methods We conducted a systematic review and reanalysed the Hormonal Contraception and HIV Acquisition (HC-HIV) study. Vaginal microbiome outcomes included bacterial vaginosis by Nugent scoring, vaginal candidiasis by culture or KOH wet mount and microbiome compositions as characterized by molecular techniques. Results Our review of 36 eligible studies found that COC and DMPA use reduce bacterial vaginosis by 10-20 and 18-30%, respectively. The HC-HIV data showed that COC and DMPA use also reduce intermediate microbiota (Nugent score of 4-6) by 11% each. In contrast, COC use (but not DMPA use) may increase vaginal candidiasis. Molecular vaginal microbiome studies (n=4) confirm that high oestrogen levels favour a vaginal microbiome composition dominated by 'healthy' Lactobacillus species; the effects of progesterone are less clear and not well studied. Conclusion DMPA use does not increase HIV risk by increasing bacterial vaginosis or vaginal candidiasis. COC use may predispose for vaginal candidiasis, but is not believed to be associated with increased HIV acquisition. However, the potential role of Candida species, and vaginal microbiome imbalances other than bacterial vaginosis or Candida species, in HIV transmission cannot yet be ruled out. Further in-depth molecular studies are needed.
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Hormonal Contraception and the risk of hiv acquisition among women in south africa
AIDS, 2012Co-Authors: Charles S Morrison, Gita Ramjee, Stephanie Skolerkarpoff, Cynthia Kwok, Pailien Chen, Janneke Van De Wijgert, Marlena Gehretplagianos, Smruti Patel, Khatija Ahmed, Barbara FriedlandAbstract:OBJECTIVES:: To evaluate the effect of Hormonal Contraception (HC) including combined oral contraceptives (COC) and the injectable progestins depo-medroxyprogesterone acetate (DMPA) and norethisterone enanthate (Net-En) on the risk of HIV acquisition among women in South Africa. DESIGN/METHODS:: We analyzed data from 5567 women ages 16-49 years participating in the Carraguard Phase 3 Efficacy Trial. Participants were interviewed about contraceptive use and sexual behaviors and underwent pelvic examinations and HIV testing quarterly. We used marginal structural Cox regression models to estimate the effect of HC exposure on HIV acquisition risk among women overall and among young women (16-24 years) in particular. RESULTS:: 270 participants became HIV-infected (3.7 per 100 wy); HIV incidence was 2.8 4.6 3.5 and 3.4 per 100 wy in the COC DMPA Net-En and non-Hormonal contraceptive groups respectively (p = 0.09). The adjusted hazard ratios (AHR) were 0.84 (95% CI 0.51-1.39) 1.28 (95% CI 0.92-1.78) and 0.92 (95% CI 0.64-1.32) among COC DMPA and Net-En users respectively compared with the non-Hormonal group controlling for covariates. Age modified the effect of Hormonal Contraception on HIV acquisition risk; among young women the adjusted HRs were 1.02 (95% CI0.46-2.28) for COCs 1.68 (95% CI 0.96-2.94) for DMPA and 1.36 (95% CI0.78-2.35) for Net-En users. CONCLUSIONS:: In this study conducted among South African women Hormonal Contraception did not significantly increase the risk of HIV acquisition. However the effect estimate does not rule out a moderate increase in HIV risk associated with DMPA use found in some other recent studies.
Joan K Kreiss - One of the best experts on this subject based on the ideXlab platform.
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Hormonal Contraception and risk of hiv 1 acquisition results of a 10 year prospective study
AIDS, 2004Co-Authors: Ludo Lavreys, Julie Overbaugh, Kishorchandra Mandaliya, J O Ndinyaachola, Jared M Baeten, Harold L Martin, Joan K KreissAbstract:The use of Hormonal Contraception has been associated with an increased risk of HIV-1 in some studies but not in others. We analysed data from a 10-year prospective cohort study of female sex workers in Mombasa, Kenya. In multivariate analysis, women using the injectable contraceptive depot medroxyprogesterone acetate and women using oral contraceptive pills were at increased risk of HIV-1 acquisition compared with women using no contraceptive method.
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the effect of Hormonal Contraception on genital tract shedding of hiv 1
AIDS, 2004Co-Authors: Chia C Wang, Scott R Mcclelland, Julie Overbaugh, Marie Reilly, Dana Panteleeff, Kishorchandra Mandaliya, Bhavna Chohan, Ludo Lavreys, J O Ndinyaachola, Joan K KreissAbstract:Objective: A previous cross-sectional study reported that Hormonal Contraception may be associated with increased infectivity in HIV-1 infected women. We conducted a prospective study to determine if cervical shedding of HIV-1 increased after initiating Hormonal Contraception. Design: Shedding of HIV-1 DNA (a marker of HIV-1 infected cells) and HIV-1 RNA were measured before and after initiating Hormonal Contraception. Methods: HIV-1 seropositive women were recruited from a Kenyan family planning clinic. At baseline, cervical secretions were collected for HIV-1 DNA and RNA assays in women initiating Hormonal Contraception; follow-up samples were collected a median of 64 days later. Results: One-hundred and one women chose depot medroxyprogesterone (Depo), 53 chose low-dose oral contraceptives (OC), seven high-dose OC, and 52 progesterone-only OC. At follow-up, there was a significant increase in the prevalence of cervical HIV-1 DNA detection [from 42% to 52%, odds ratio (OR), 1.62; 95% confidence interval (Cl), 1.03-2.63) for all Hormonal Contraception combined, and a trend for an increase for each individual type. Although the prevalence of cervical HIV-1 RNA increased slightly (from 82% to 86%; OR, 1.56; 95% Cl, 0.83-3.03), the concentration of cervical HIV-1 RNA did not change significantly overall (from 2.81 to 2.84 log 10 copies/swab; P= 0.77) or for individual Contraception types. Conclusions: A modest but significant increase in shedding of HIV-1 DNA but not of HIV-1 RNA was detected after starting Hormonal Contraception. Our results may have important implications regarding the infectivity of women using Hormonal Contraception, and highlight the need for epidemiologic studies of transmission rates from women using and not using Hormonal Contraception.
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Hormonal Contraception and risk of sexually transmitted disease acquisition results from a prospective study
American Journal of Obstetrics and Gynecology, 2001Co-Authors: Jared M Baeten, Kishorchandra Mandaliya, Bhavna Chohan, Ludo Lavreys, J O Ndinyaachola, Harold L Martin, Patrick M Nyange, Barbra A Richardson, Job J Bwayo, Joan K KreissAbstract:Abstract Objectives: To examine the relationship between use of oral contraceptive pills or depot medroxyprogesterone acetate and sexually transmitted disease acquisition. Study Design: Prospective cohort included 948 Kenyan prostitutes. Multivariate Andersen-Gill proportional hazards models were constructed, adjusting for sexual behavioral and demographic variables. Results: When compared with women who were using no Contraception, users of oral contraceptive pills were at increased risk for acquisition of chlamydia (hazard ratio, 1.8; 95% confidence interval, 1.1-2.9) and vaginal candidiasis (hazard ratio, 1.5; 95% confidence interval, 1.2-1.9) and at decreased risk for bacterial vaginosis (hazard ratio, 0.8; 95% confidence interval, 0.7-1.0). Women using depot medroxyprogesterone acetate had significantly increased risk of chlamydia infection (hazard ratio, 1.6; 95% confidence interval, 1.1-2.4) and significantly decreased risk of bacterial vaginosis (hazard ratio, 0.7; 95% confidence interval, 0.5-0.8), trichomoniasis (hazard ratio, 0.6; 95% confidence interval, 0.4-1.0), and pelvic inflammatory disease (hazard ratio, 0.4; 95% confidence interval, 0.2-0.7). Consistent condom use was associated with significantly decreased risk of gonorrhea, chlamydia, genital ulcer disease, bacterial vaginosis, and pelvic inflammatory disease. Conclusions: The use of oral or injectable Hormonal Contraception altered susceptibility to sexually transmitted diseases, which may in turn influence transmission of human immunodeficiency virus type 1. Consistent condom use was protective with regards to sexually transmitted disease and should be encouraged for the prevention of sexually transmitted disease and human immunodeficiency virus type 1 among women who use Hormonal Contraception. (Am J Obstet Gynecol 2001;185:380-85)
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cervical shedding of herpes simplex virus in human immunodeficiency virus infected women effects of Hormonal Contraception pregnancy and vitamin a deficiency
The Journal of Infectious Diseases, 2000Co-Authors: Sara B Mostad, Kishorchandra Mandaliya, Bhavna Chohan, J O Ndinyaachola, Joan K Kreiss, Job J Bwayo, Alexander J Ryncarz, Lawrence CoreyAbstract:Genital shedding of herpes simplex virus (HSV) results in frequent transmission of infection to sexual partners and neonates. In a cross-sectional study, cervical shedding of HSV DNA was detected in 43 (17%) cervical swab samples from 273 women seropositive for HSV-1, HSV-2, and human immunodeficiency virus type 1 (HIV-1). Cervical shedding of HSV was significantly associated with oral Contraception (adjusted odds ratio [aOR], 4.5; 95% confidence interval [CI], 1.7-12.2), use of depo-medroxyprogesterone acetate (aOR, 3.2; 95% CI, 1.3-7.7), and pregnancy (aOR, 7.9; 95% CI, 2.0-31.7). In the subgroup of women who were not pregnant and not using Hormonal Contraception (n = 178), serum vitamin A was highly predictive of cervical HSV shedding: concentrations indicating severe deficiency, moderate deficiency, low-normal, and high-normal status were associated with 29%, 18%, 8%, and 2% prevalences of cervical HSV shedding, respectively (linear trend, P = .0002). Several factors appear to influence HSV reactivation in HIV-1 seropositive women.
Ojvind Lidegaard - One of the best experts on this subject based on the ideXlab platform.
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contemporary Hormonal Contraception and the risk of breast cancer
The New England Journal of Medicine, 2017Co-Authors: Lina Steinrud Morch, Charlotte Wessel Skovlund, Philip C Hannaford, Lisa Iversen, Shona Fielding, Ojvind LidegaardAbstract:BackgroundLittle is known about whether contemporary Hormonal Contraception is associated with an increased risk of breast cancer. MethodsWe assessed associations between the use of Hormonal Contraception and the risk of invasive breast cancer in a nationwide prospective cohort study involving all women in Denmark between 15 and 49 years of age who had not had cancer or venous thromboembolism and who had not received treatment for infertility. Nationwide registries provided individually updated information about the use of Hormonal Contraception, breast-cancer diagnoses, and potential confounders. ResultsAmong 1.8 million women who were followed on average for 10.9 years (a total of 19.6 million person-years), 11,517 cases of breast cancer occurred. As compared with women who had never used Hormonal Contraception, the relative risk of breast cancer among all current and recent users of Hormonal Contraception was 1.20 (95% confidence interval [CI], 1.14 to 1.26). This risk increased from 1.09 (95% CI, 0.96...
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association of Hormonal Contraception with suicide attempts and suicides
American Journal of Psychiatry, 2017Co-Authors: Charlotte Wessel Skovlund, Lina Steinrud Morch, Lars Vedel Kessing, Theis Lange, Ojvind LidegaardAbstract:Objective:The purpose of this study was to assess the relative risk of suicide attempt and suicide in users of Hormonal Contraception.Method:The authors assessed associations between Hormonal contraceptive use and suicide attempt and suicide in a nationwide prospective cohort study of all women in Denmark who had no psychiatric diagnoses, antidepressant use, or Hormonal contraceptive use before age 15 and who turned 15 during the study period, which extended from 1996 through 2013. Nationwide registers provided individually updated information about use of Hormonal Contraception, suicide attempt, suicide, and potential confounding variables. Psychiatric diagnoses or antidepressant use during the study period were considered potential mediators between Hormonal contraceptive use and risk of suicide attempt. Adjusted hazard ratios for suicide attempt and suicide were estimated for users of Hormonal Contraception as compared with those who never used Hormonal Contraception.Results:Among nearly half a million...
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association of Hormonal Contraception with depression
JAMA Psychiatry, 2016Co-Authors: Charlotte Wessel Skovlund, Lina Steinrud Morch, Lars Vedel Kessing, Ojvind LidegaardAbstract:Importance Millions of women worldwide use Hormonal Contraception. Despite the clinical evidence of an influence of Hormonal Contraception on some women’s mood, associations between the use of Hormonal Contraception and mood disturbances remain inadequately addressed. Objective To investigate whether the use of Hormonal Contraception is positively associated with subsequent use of antidepressants and a diagnosis of depression at a psychiatric hospital. Design, Setting, and Participants This nationwide prospective cohort study combined data from the National Prescription Register and the Psychiatric Central Research Register in Denmark. All women and adolescents aged 15 to 34 years who were living in Denmark were followed up from January 1, 2000, to December 2013, if they had no prior depression diagnosis, redeemed prescription for antidepressants, other major psychiatric diagnosis, cancer, venous thrombosis, or infertility treatment. Data were collected from January 1, 1995, to December 31, 2013, and analyzed from January 1, 2015, through April 1, 2016. Exposures Use of different types of Hormonal Contraception. Main Outcomes and Measures With time-varying covariates, adjusted incidence rate ratios (RRs) were calculated for first use of an antidepressant and first diagnosis of depression at a psychiatric hospital. Results A total of 1 061 997 women (mean [SD] age, 24.4 [0.001] years; mean [SD] follow-up, 6.4 [0.004] years) were included in the analysis. Compared with nonusers, users of combined oral contraceptives had an RR of first use of an antidepressant of 1.23 (95% CI, 1.22-1.25). Users of progestogen-only pills had an RR for first use of an antidepressant of 1.34 (95% CI, 1.27-1.40); users of a patch (norgestrolmin), 2.0 (95% CI, 1.76-2.18); users of a vaginal ring (etonogestrel), 1.6 (95% CI, 1.55-1.69); and users of a levonorgestrel intrauterine system, 1.4 (95% CI, 1.31-1.42). For depression diagnoses, similar or slightly lower estimates were found. The relative risks generally decreased with increasing age. Adolescents (age range, 15-19 years) using combined oral contraceptives had an RR of a first use of an antidepressant of 1.8 (95% CI, 1.75-1.84) and those using progestin-only pills, 2.2 (95% CI, 1.99-2.52). Six months after starting use of Hormonal contraceptives, the RR of antidepressant use peaked at 1.4 (95% CI, 1.34-1.46). When the reference group was changed to those who never used Hormonal Contraception, the RR estimates for users of combined oral contraceptives increased to 1.7 (95% CI, 1.66-1.71). Conclusions and Relevance Use of Hormonal Contraception, especially among adolescents, was associated with subsequent use of antidepressants and a first diagnosis of depression, suggesting depression as a potential adverse effect of Hormonal contraceptive use.
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Hormonal Contraception and venous thromboembolism
Acta Obstetricia et Gynecologica Scandinavica, 2012Co-Authors: Ojvind Lidegaard, Ian Milsom, Reynir Tomas Geirsson, Finn Egil SkjeldestadAbstract:BACKGROUND: New studies about the influence of Hormonal Contraception on the risk of venous thromboembolism (VTE) have been published. AIM: To evaluate new epidemiological data and to propose clinical consequences. DESIGN: A literature survey. METHODS: Studies assessing the risk of specific types of Hormonal Contraception were evaluated compared and set into a clinical perspective. RESULTS: The majority of newer studies have demonstrated a threefold increased risk of VTE in current users of medium- and low-dose combined oral contraceptives (COCs) with norethisterone levonorgestrel (LNG) or norgestimate compared with non-users. The same studies have demonstrated a sixfold increased risk of VTE in users of combined pills with desogestrel gestodene drospirenone or cyproteroneacetate and in users of the contraceptive vaginal ring compared with non-users. The rate ratio of VTE between users of COCs with newer progestogens compared with users of COCs with LNG was 1.5-2.8 in seven studies and 1.0 in two studies. Progestogen-only Contraception did not confer an increased risk of VTE in any study. The incidence rate of VTE in non-pregnant women aged 15-49 years using non-Hormonal Contraception is three per 10 000 years. CONCLUSIONS: For women starting on Hormonal Contraception we recommend medium- or low-dose combined pills with norethisterone LNG or norgestimate as first-choice preparations. For the many women who are users of COCs with newer progestogens although the absolute risk of VTE is low a change to combined pills with norethisterone LNG or norgestimate may halve their risk of VTE. Finally we recommend COCs with 20 mug estrogen combined with the older progestogens to be launched in the Scandinavian countries. Women at an increased risk of VTE should consider progestogen-only Contraception or non-Hormonal Contraception. (c) 2012 The Authors Acta Obstetricia et Gynecologica Scandinavica(c) 2012 Nordic Federation of Societies of Obstetrics and Gynecology.
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thrombotic stroke and myocardial infarction with Hormonal Contraception
The New England Journal of Medicine, 2012Co-Authors: Ojvind Lidegaard, Charlotte Wessel Skovlund, A S Jensen, Niels KeidingAbstract:METHODS In this 15-year Danish historical cohort study, we followed nonpregnant women, 15 to 49 years old, with no history of cardiovascular disease or cancer. Data on use of Hormonal Contraception, clinical end points, and potential confounders were obtained from four national registries. RESULTS A total of 1,626,158 women contributed 14,251,063 person-years of observation, during which 3311 thrombotic strokes (21.4 per 100,000 person-years) and 1725 myocardial infarctions (10.1 per 100,000 person-years) occurred. As compared with nonuse, current use of oral contraceptives that included ethinyl estradiol at a dose of 30 to 40 μg was associated with the following relative risks (and 95% confidence intervals) for thrombotic stroke and myocardial infarction, according to progestin type: norethindrone, 2.2 (1.5 to 3.2) and 2.3 (1.3 to 3.9); levonorgestrel, 1.7 (1.4 to 2.0) and 2.0 (1.6 to 2.5); norgestimate, 1.5 (1.2 to 1.9) and 1.3 (0.9 to 1.9); desogestrel, 2.2 (1.8 to 2.7) and 2.1 (1.5 to 2.8); gestodene, 1.8 (1.6 to 2.0) and 1.9 (1.6 to 2.3); and drospirenone, 1.6 (1.2 to 2.2) and 1.7 (1.0 to 2.6), respectively. With ethinyl estradiol at a dose of 20 μg, the corresponding relative risks according to progestin type were as follows: desogestrel, 1.5 (1.3 to 1.9) and 1.6 (1.1 to 2.1); gestodene, 1.7 (1.4 to 2.1) and 1.2 (0.8 to 1.9); and drospirenone, 0.9 (0.2 to 3.5) and 0.0. For transdermal patches, the corresponding relative risks were 3.2 (0.8 to 12.6) and 0.0, and for a vaginal ring, 2.5 (1.4 to 4.4) and 2.1 (0.7 to 6.5). CONCLUSIONS Although the absolute risks of thrombotic stroke and myocardial infarction associated with the use of Hormonal Contraception were low, the risk was increased by a factor of 0.9 to 1.7 with oral contraceptives that included ethinyl estradiol at a dose of 20 μg and by a factor of 1.3 to 2.3 with those that included ethinyl estradiol at a dose of 30 to 40 μg, with relatively small differences in risk according to progestin type. (Funded by the Danish Heart Association.)
Jared M Baeten - One of the best experts on this subject based on the ideXlab platform.
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Hormonal Contraception and the risk of HIV acquisition: an individual participant data meta-analysis.
Public Library of Science (PLoS), 2015Co-Authors: Charles S Morrison, Jared M Baeten, Cynthia Kwok, Pailien Chen, Joelle Brown, Angela M Crook, Lut Van Damme, Sinead Delany-moretlwe, Suzanna C Francis, Barbara A FriedlandAbstract:Observational studies of a putative association between Hormonal Contraception (HC) and HIV acquisition have produced conflicting results. We conducted an individual participant data (IPD) meta-analysis of studies from sub-Saharan Africa to compare the incidence of HIV infection in women using combined oral contraceptives (COCs) or the injectable progestins depot-medroxyprogesterone acetate (DMPA) or norethisterone enanthate (NET-EN) with women not using HC.Eligible studies measured HC exposure and incident HIV infection prospectively using standardized measures, enrolled women aged 15-49 y, recorded ≥15 incident HIV infections, and measured prespecified covariates. Our primary analysis estimated the adjusted hazard ratio (aHR) using two-stage random effects meta-analysis, controlling for region, marital status, age, number of sex partners, and condom use. We included 18 studies, including 37,124 women (43,613 woman-years) and 1,830 incident HIV infections. Relative to no HC use, the aHR for HIV acquisition was 1.50 (95% CI 1.24-1.83) for DMPA use, 1.24 (95% CI 0.84-1.82) for NET-EN use, and 1.03 (95% CI 0.88-1.20) for COC use. Between-study heterogeneity was mild (I(2) < 50%). DMPA use was associated with increased HIV acquisition compared with COC use (aHR 1.43, 95% CI 1.23-1.67) and NET-EN use (aHR 1.32, 95% CI 1.08-1.61). Effect estimates were attenuated for studies at lower risk of methodological bias (compared with no HC use, aHR for DMPA use 1.22, 95% CI 0.99-1.50; for NET-EN use 0.67, 95% CI 0.47-0.96; and for COC use 0.91, 95% CI 0.73-1.41) compared to those at higher risk of bias (p(interaction) = 0.003). Neither age nor herpes simplex virus type 2 infection status modified the HC-HIV relationship.This IPD meta-analysis found no evidence that COC or NET-EN use increases women's risk of HIV but adds to the evidence that DMPA may increase HIV risk, underscoring the need for additional safe and effective contraceptive options for women at high HIV risk. A randomized controlled trial would provide more definitive evidence about the effects of Hormonal Contraception, particularly DMPA, on HIV risk
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Hormonal Contraception and the Risk of HIV Acquisition: An Individual Participant Data Meta-analysis
2015Co-Authors: Charles S Morrison, Jared M Baeten, Cynthia Kwok, Pailien Chen, Joelle Brown, Angela M Crook, Lut Van Damme, Sinead Delany-moretlwe, Suzanna C Francis, Barbara A FriedlandAbstract:BackgroundObservational studies of a putative association between Hormonal Contraception (HC) and HIV acquisition have produced conflicting results. We conducted an individual participant data (IPD) meta-analysis of studies from sub-Saharan Africa to compare the incidence of HIV infection in women using combined oral contraceptives (COCs) or the injectable progestins depot-medroxyprogesterone acetate (DMPA) or norethisterone enanthate (NET-EN) with women not using HC.Methods and FindingsEligible studies measured HC exposure and incident HIV infection prospectively using standardized measures, enrolled women aged 15–49 y, recorded ≥15 incident HIV infections, and measured prespecified covariates. Our primary analysis estimated the adjusted hazard ratio (aHR) using two-stage random effects meta-analysis, controlling for region, marital status, age, number of sex partners, and condom use. We included 18 studies, including 37,124 women (43,613 woman-years) and 1,830 incident HIV infections. Relative to no HC use, the aHR for HIV acquisition was 1.50 (95% CI 1.24–1.83) for DMPA use, 1.24 (95% CI 0.84–1.82) for NET-EN use, and 1.03 (95% CI 0.88–1.20) for COC use. Between-study heterogeneity was mild (I2 < 50%). DMPA use was associated with increased HIV acquisition compared with COC use (aHR 1.43, 95% CI 1.23–1.67) and NET-EN use (aHR 1.32, 95% CI 1.08–1.61). Effect estimates were attenuated for studies at lower risk of methodological bias (compared with no HC use, aHR for DMPA use 1.22, 95% CI 0.99–1.50; for NET-EN use 0.67, 95% CI 0.47–0.96; and for COC use 0.91, 95% CI 0.73–1.41) compared to those at higher risk of bias (pinteraction = 0.003). Neither age nor herpes simplex virus type 2 infection status modified the HC–HIV relationship.ConclusionsThis IPD meta-analysis found no evidence that COC or NET-EN use increases women’s risk of HIV but adds to the evidence that DMPA may increase HIV risk, underscoring the need for additional safe and effective contraceptive options for women at high HIV risk. A randomized controlled trial would provide more definitive evidence about the effects of Hormonal Contraception, particularly DMPA, on HIV risk.
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Hormonal Contraception and hiv 1 transmission
American Journal of Reproductive Immunology, 2011Co-Authors: Catherine A Blish, Jared M BaetenAbstract:Safe and effective contraceptive choices are essential for women with HIV-1 infection and at risk for HIV-1 infection. Epidemiological and laboratory-based studies suggest that Hormonal Contraception may influence HIV-1 transmission. Several large studies in high-risk populations indicate that Hormonal contraceptive use may modestly increase the risk of HIV-1 acquisition. In addition, HIV-1-infected users of Hormonal contraceptives may be more infectious to their uninfected partners, although no studies have directly measured HIV-1 transmission risk from women to men. However, several studies failed to demonstrate a link between contraceptive use and HIV-1 acquisition or transmission, and interpretation of many studies limited by methodological considerations, such as infrequent measurements of contraceptive exposure and HIV-1 status. As a result, many questions remain, and high-quality studies remain needed. It is clear that Hormonal contraceptives are not protective against HIV-1 infection, and that dual protection with condoms should be the goal for women using Hormonal Contraception.
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Hormonal Contraception and risk of hiv 1 acquisition results of a 10 year prospective study
AIDS, 2004Co-Authors: Ludo Lavreys, Julie Overbaugh, Kishorchandra Mandaliya, J O Ndinyaachola, Jared M Baeten, Harold L Martin, Joan K KreissAbstract:The use of Hormonal Contraception has been associated with an increased risk of HIV-1 in some studies but not in others. We analysed data from a 10-year prospective cohort study of female sex workers in Mombasa, Kenya. In multivariate analysis, women using the injectable contraceptive depot medroxyprogesterone acetate and women using oral contraceptive pills were at increased risk of HIV-1 acquisition compared with women using no contraceptive method.
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Hormonal Contraception and risk of sexually transmitted disease acquisition results from a prospective study
American Journal of Obstetrics and Gynecology, 2001Co-Authors: Jared M Baeten, Kishorchandra Mandaliya, Bhavna Chohan, Ludo Lavreys, J O Ndinyaachola, Harold L Martin, Patrick M Nyange, Barbra A Richardson, Job J Bwayo, Joan K KreissAbstract:Abstract Objectives: To examine the relationship between use of oral contraceptive pills or depot medroxyprogesterone acetate and sexually transmitted disease acquisition. Study Design: Prospective cohort included 948 Kenyan prostitutes. Multivariate Andersen-Gill proportional hazards models were constructed, adjusting for sexual behavioral and demographic variables. Results: When compared with women who were using no Contraception, users of oral contraceptive pills were at increased risk for acquisition of chlamydia (hazard ratio, 1.8; 95% confidence interval, 1.1-2.9) and vaginal candidiasis (hazard ratio, 1.5; 95% confidence interval, 1.2-1.9) and at decreased risk for bacterial vaginosis (hazard ratio, 0.8; 95% confidence interval, 0.7-1.0). Women using depot medroxyprogesterone acetate had significantly increased risk of chlamydia infection (hazard ratio, 1.6; 95% confidence interval, 1.1-2.4) and significantly decreased risk of bacterial vaginosis (hazard ratio, 0.7; 95% confidence interval, 0.5-0.8), trichomoniasis (hazard ratio, 0.6; 95% confidence interval, 0.4-1.0), and pelvic inflammatory disease (hazard ratio, 0.4; 95% confidence interval, 0.2-0.7). Consistent condom use was associated with significantly decreased risk of gonorrhea, chlamydia, genital ulcer disease, bacterial vaginosis, and pelvic inflammatory disease. Conclusions: The use of oral or injectable Hormonal Contraception altered susceptibility to sexually transmitted diseases, which may in turn influence transmission of human immunodeficiency virus type 1. Consistent condom use was protective with regards to sexually transmitted disease and should be encouraged for the prevention of sexually transmitted disease and human immunodeficiency virus type 1 among women who use Hormonal Contraception. (Am J Obstet Gynecol 2001;185:380-85)
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cervical shedding of herpes simplex virus in human immunodeficiency virus infected women effects of Hormonal Contraception pregnancy and vitamin a deficiency
The Journal of Infectious Diseases, 2000Co-Authors: Sara B Mostad, Kishorchandra Mandaliya, Bhavna Chohan, J O Ndinyaachola, Joan K Kreiss, Job J Bwayo, Alexander J Ryncarz, Lawrence CoreyAbstract:Genital shedding of herpes simplex virus (HSV) results in frequent transmission of infection to sexual partners and neonates. In a cross-sectional study, cervical shedding of HSV DNA was detected in 43 (17%) cervical swab samples from 273 women seropositive for HSV-1, HSV-2, and human immunodeficiency virus type 1 (HIV-1). Cervical shedding of HSV was significantly associated with oral Contraception (adjusted odds ratio [aOR], 4.5; 95% confidence interval [CI], 1.7-12.2), use of depo-medroxyprogesterone acetate (aOR, 3.2; 95% CI, 1.3-7.7), and pregnancy (aOR, 7.9; 95% CI, 2.0-31.7). In the subgroup of women who were not pregnant and not using Hormonal Contraception (n = 178), serum vitamin A was highly predictive of cervical HSV shedding: concentrations indicating severe deficiency, moderate deficiency, low-normal, and high-normal status were associated with 29%, 18%, 8%, and 2% prevalences of cervical HSV shedding, respectively (linear trend, P = .0002). Several factors appear to influence HSV reactivation in HIV-1 seropositive women.