Effect of concurrent use of anti-retroviral therapy and levonorgestrel sub-dermal implant for contraception on CD4 counts: a prospective cohort study in Kenya
Effect of concurrent use of anti-retroviral therapy and levonorgestrel sub-dermal implant for contraception on CD4 counts: a prospective cohort study in Kenya
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DOI：
10.7448/ias.16.1.18448
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发表时间：
2013-03-01
影响因子：
6
通讯作者：
Chen, Pai-Lien
中科院分区：
文献类型：
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作者：
Hubacher, David;Liku, Jennifer;Chen, Pai-Lien
同时使用避孕激素和抗逆转录病毒疗法（ART）理论上可能会降低两者的有效性。接受抗逆转录病毒治疗的妇女需要保证激素避孕是安全有效的。皮下植入物是一种理想的产品研究：低和稳定的restestin释放，没有粘附的不确定性。我们试图确定药物的有效性是compromised.Methods：我们进行了一项前瞻性队列研究中的妇女第一线ART（司他夫定或齐多夫定和拉米夫定+奈韦拉平）。我们招募了新的植入物使用者，并根据年龄和基线CD 4将他们与未使用激素避孕的女性进行匹配。参与者被前瞻性随访长达两年，记录连续的CD 4测量和病史。我们使用广义生长曲线模型和Wald卡方检验比较研究组间CD 4计数的变化。如果发生以下任何事件，则对前瞻性CD 4测量值进行删失（排除）：对照组中ART改变、植入物取出或使用任何激素避孕。我们研究了机会性感染和怀孕的发病率。结果：我们匹配48植入用户33非激素对照。随着时间的推移，两组的CD 4计数略有上升，但彼此没有显著偏离（p = 0.44）。两组之间的寄生虫感染率没有差异。没有植入物的用户和一个非激素控制怀孕在follow-up.Conclusions：这项小型研究发现，同时使用避孕植入物和ART是安全有效的。虽然其他激素避孕产品和ART方案可能以未知的方式相互作用，但这项研究的结果令人放心。
Introduction: Simultaneous use of contraceptive hormones and anti-retroviral therapy (ART) may theoretically lessen the effectiveness of both. Women on ART need assurance that hormonal contraception is safe and effective. The sub-dermal implant is an ideal product to study: low and steady progestin release and no adherence uncertainties. We sought to determine if the medications' effectiveness is compromised.Methods: We conducted a prospective cohort study among women on first line ART (stavudine or zidovudine and lamivudine + nevirapine). We recruited new implant users and matched them to women not using hormonal contraception, based on age and baseline CD4. Participants were followed prospectively for up to two years, recording serial CD4 measures and medical histories. We used generalized growth curve models and Wald chi-square tests to compare changes in CD4 counts across study groups. Prospective CD4 measures were censored (excluded) if any of the following events occurred: change in ART, implant removal or use of any hormonal contraception among controls. We examined incidence of opportunistic infection and pregnancy.Results: We matched 48 implant users to 33 non-hormonal controls. Over time, CD4 counts for both groups rose slightly but did not deviate significantly from each other (p = 0.44). Opportunistic infection rates did not differ between the groups. None of the implant users and one of the non-hormonal controls became pregnant during follow-up.Conclusions: This small study found concurrent use of contraceptive implants and ART to be safe and effective. Although other hormonal contraceptive products and ART regimens may interact in unknown ways, the results of this study are reassuring.