Cargando…

A retrospective cohort analysis comparing pregnancy rates among HIV-positive women using contraceptives and efavirenz- or nevirapine-based antiretroviral therapy in Kenya

BACKGROUND: Given recent concerns of efavirenz reducing the efficacy of contraceptive implants, we sought to determine if pregnancy rates differ among HIV-positive women using various contraceptive methods and efavirenz- or nevirapine-based antiretroviral therapy (ART) regimens. METHODS: We conducte...

Descripción completa

Detalles Bibliográficos
Autores principales: PATEL, Rena C., ONONO, Maricianah, GANDHI, Monica, BLAT, Cinthia, HAGEY, Jill, SHADE, Starley B., VITTINGHOFF, Eric, BUKUSI, Elizabeth A., NEWMANN, Sara J., COHEN, Craig R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4632202/
https://www.ncbi.nlm.nih.gov/pubmed/26520927
http://dx.doi.org/10.1016/S2352-3018(15)00184-8
_version_ 1782398977527775232
author PATEL, Rena C.
ONONO, Maricianah
GANDHI, Monica
BLAT, Cinthia
HAGEY, Jill
SHADE, Starley B.
VITTINGHOFF, Eric
BUKUSI, Elizabeth A.
NEWMANN, Sara J.
COHEN, Craig R.
author_facet PATEL, Rena C.
ONONO, Maricianah
GANDHI, Monica
BLAT, Cinthia
HAGEY, Jill
SHADE, Starley B.
VITTINGHOFF, Eric
BUKUSI, Elizabeth A.
NEWMANN, Sara J.
COHEN, Craig R.
author_sort PATEL, Rena C.
collection PubMed
description BACKGROUND: Given recent concerns of efavirenz reducing the efficacy of contraceptive implants, we sought to determine if pregnancy rates differ among HIV-positive women using various contraceptive methods and efavirenz- or nevirapine-based antiretroviral therapy (ART) regimens. METHODS: We conducted a retrospective cohort analysis of HIV-positive women aged 15–45 years enrolled in HIV care facilities in western Kenya from January 2011 to December 2013. Pregnancy was diagnosed clinically and the primary exposure was a combination of contraceptive method and ART regimen. We used Poisson models, adjusting for repeated measures, as well as demographic, behavioral and clinical factors, to compare pregnancy rates among women on different contraceptive/ART combinations. FINDINGS: 24,560 women contributed 37,635 years of follow-up with 3,337 incident pregnancies. Among women using implants, adjusted pregnancy incidence for nevirapine- and efavirenz-based ART users were 1·1 (95% CI 0·72–1·5) and 3·3 (95% CI 1·8–4·8) per 100 women-years (w-y), respectively (adjusted incidence rate ratio (aIRR) 3·0, 95% CI 1·3–4·6). Among women using depomedroxyprogesterone acetate (DMPA), adjusted pregnancy incidence for nevirapine- and efavirenz-based ART users were 4·5 (95% CI 3·7–5·2) and 5·4 (95% CI 4·0–6·8) per 100 w-y, respectively (aIRR 1·2, 95% CI 0·91–1·5). Women using other contraceptive methods, except for intrauterine devices and permanent methods, experienced 3·1–4·1 higher rates of pregnancy than women using implants, with 1·6–2·8 higher rates specifically among women using efavirenz-based ART. INTERPRETATION: While HIV-positive women using implants on efavirenz-based ART faced three times higher risk of contraceptive failure than those on nevirapine-based ART, these women still experienced lower contraceptive failure rates than women on all other contraceptive methods, except for intrauterine devices and permanent methods. Guidelines for contraceptive and ART combinations should balance the failure rates for each contraceptive method and ART regimen combination against the high effectiveness of implants. FUNDING: Supported by the President’s Emergency Plan for AIDS Relief and the Centers for Disease Control and Prevention.
format Online
Article
Text
id pubmed-4632202
institution National Center for Biotechnology Information
language English
publishDate 2015
record_format MEDLINE/PubMed
spelling pubmed-46322022016-11-01 A retrospective cohort analysis comparing pregnancy rates among HIV-positive women using contraceptives and efavirenz- or nevirapine-based antiretroviral therapy in Kenya PATEL, Rena C. ONONO, Maricianah GANDHI, Monica BLAT, Cinthia HAGEY, Jill SHADE, Starley B. VITTINGHOFF, Eric BUKUSI, Elizabeth A. NEWMANN, Sara J. COHEN, Craig R. Lancet HIV Article BACKGROUND: Given recent concerns of efavirenz reducing the efficacy of contraceptive implants, we sought to determine if pregnancy rates differ among HIV-positive women using various contraceptive methods and efavirenz- or nevirapine-based antiretroviral therapy (ART) regimens. METHODS: We conducted a retrospective cohort analysis of HIV-positive women aged 15–45 years enrolled in HIV care facilities in western Kenya from January 2011 to December 2013. Pregnancy was diagnosed clinically and the primary exposure was a combination of contraceptive method and ART regimen. We used Poisson models, adjusting for repeated measures, as well as demographic, behavioral and clinical factors, to compare pregnancy rates among women on different contraceptive/ART combinations. FINDINGS: 24,560 women contributed 37,635 years of follow-up with 3,337 incident pregnancies. Among women using implants, adjusted pregnancy incidence for nevirapine- and efavirenz-based ART users were 1·1 (95% CI 0·72–1·5) and 3·3 (95% CI 1·8–4·8) per 100 women-years (w-y), respectively (adjusted incidence rate ratio (aIRR) 3·0, 95% CI 1·3–4·6). Among women using depomedroxyprogesterone acetate (DMPA), adjusted pregnancy incidence for nevirapine- and efavirenz-based ART users were 4·5 (95% CI 3·7–5·2) and 5·4 (95% CI 4·0–6·8) per 100 w-y, respectively (aIRR 1·2, 95% CI 0·91–1·5). Women using other contraceptive methods, except for intrauterine devices and permanent methods, experienced 3·1–4·1 higher rates of pregnancy than women using implants, with 1·6–2·8 higher rates specifically among women using efavirenz-based ART. INTERPRETATION: While HIV-positive women using implants on efavirenz-based ART faced three times higher risk of contraceptive failure than those on nevirapine-based ART, these women still experienced lower contraceptive failure rates than women on all other contraceptive methods, except for intrauterine devices and permanent methods. Guidelines for contraceptive and ART combinations should balance the failure rates for each contraceptive method and ART regimen combination against the high effectiveness of implants. FUNDING: Supported by the President’s Emergency Plan for AIDS Relief and the Centers for Disease Control and Prevention. 2015-10-22 2015-11 /pmc/articles/PMC4632202/ /pubmed/26520927 http://dx.doi.org/10.1016/S2352-3018(15)00184-8 Text en http://creativecommons.org/licenses/by-nc-nd/4.0/ This manuscript version is made available under the CC BY-NC-ND 4.0 license.
spellingShingle Article
PATEL, Rena C.
ONONO, Maricianah
GANDHI, Monica
BLAT, Cinthia
HAGEY, Jill
SHADE, Starley B.
VITTINGHOFF, Eric
BUKUSI, Elizabeth A.
NEWMANN, Sara J.
COHEN, Craig R.
A retrospective cohort analysis comparing pregnancy rates among HIV-positive women using contraceptives and efavirenz- or nevirapine-based antiretroviral therapy in Kenya
title A retrospective cohort analysis comparing pregnancy rates among HIV-positive women using contraceptives and efavirenz- or nevirapine-based antiretroviral therapy in Kenya
title_full A retrospective cohort analysis comparing pregnancy rates among HIV-positive women using contraceptives and efavirenz- or nevirapine-based antiretroviral therapy in Kenya
title_fullStr A retrospective cohort analysis comparing pregnancy rates among HIV-positive women using contraceptives and efavirenz- or nevirapine-based antiretroviral therapy in Kenya
title_full_unstemmed A retrospective cohort analysis comparing pregnancy rates among HIV-positive women using contraceptives and efavirenz- or nevirapine-based antiretroviral therapy in Kenya
title_short A retrospective cohort analysis comparing pregnancy rates among HIV-positive women using contraceptives and efavirenz- or nevirapine-based antiretroviral therapy in Kenya
title_sort retrospective cohort analysis comparing pregnancy rates among hiv-positive women using contraceptives and efavirenz- or nevirapine-based antiretroviral therapy in kenya
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4632202/
https://www.ncbi.nlm.nih.gov/pubmed/26520927
http://dx.doi.org/10.1016/S2352-3018(15)00184-8
work_keys_str_mv AT patelrenac aretrospectivecohortanalysiscomparingpregnancyratesamonghivpositivewomenusingcontraceptivesandefavirenzornevirapinebasedantiretroviraltherapyinkenya
AT ononomaricianah aretrospectivecohortanalysiscomparingpregnancyratesamonghivpositivewomenusingcontraceptivesandefavirenzornevirapinebasedantiretroviraltherapyinkenya
AT gandhimonica aretrospectivecohortanalysiscomparingpregnancyratesamonghivpositivewomenusingcontraceptivesandefavirenzornevirapinebasedantiretroviraltherapyinkenya
AT blatcinthia aretrospectivecohortanalysiscomparingpregnancyratesamonghivpositivewomenusingcontraceptivesandefavirenzornevirapinebasedantiretroviraltherapyinkenya
AT hageyjill aretrospectivecohortanalysiscomparingpregnancyratesamonghivpositivewomenusingcontraceptivesandefavirenzornevirapinebasedantiretroviraltherapyinkenya
AT shadestarleyb aretrospectivecohortanalysiscomparingpregnancyratesamonghivpositivewomenusingcontraceptivesandefavirenzornevirapinebasedantiretroviraltherapyinkenya
AT vittinghofferic aretrospectivecohortanalysiscomparingpregnancyratesamonghivpositivewomenusingcontraceptivesandefavirenzornevirapinebasedantiretroviraltherapyinkenya
AT bukusielizabetha aretrospectivecohortanalysiscomparingpregnancyratesamonghivpositivewomenusingcontraceptivesandefavirenzornevirapinebasedantiretroviraltherapyinkenya
AT newmannsaraj aretrospectivecohortanalysiscomparingpregnancyratesamonghivpositivewomenusingcontraceptivesandefavirenzornevirapinebasedantiretroviraltherapyinkenya
AT cohencraigr aretrospectivecohortanalysiscomparingpregnancyratesamonghivpositivewomenusingcontraceptivesandefavirenzornevirapinebasedantiretroviraltherapyinkenya
AT patelrenac retrospectivecohortanalysiscomparingpregnancyratesamonghivpositivewomenusingcontraceptivesandefavirenzornevirapinebasedantiretroviraltherapyinkenya
AT ononomaricianah retrospectivecohortanalysiscomparingpregnancyratesamonghivpositivewomenusingcontraceptivesandefavirenzornevirapinebasedantiretroviraltherapyinkenya
AT gandhimonica retrospectivecohortanalysiscomparingpregnancyratesamonghivpositivewomenusingcontraceptivesandefavirenzornevirapinebasedantiretroviraltherapyinkenya
AT blatcinthia retrospectivecohortanalysiscomparingpregnancyratesamonghivpositivewomenusingcontraceptivesandefavirenzornevirapinebasedantiretroviraltherapyinkenya
AT hageyjill retrospectivecohortanalysiscomparingpregnancyratesamonghivpositivewomenusingcontraceptivesandefavirenzornevirapinebasedantiretroviraltherapyinkenya
AT shadestarleyb retrospectivecohortanalysiscomparingpregnancyratesamonghivpositivewomenusingcontraceptivesandefavirenzornevirapinebasedantiretroviraltherapyinkenya
AT vittinghofferic retrospectivecohortanalysiscomparingpregnancyratesamonghivpositivewomenusingcontraceptivesandefavirenzornevirapinebasedantiretroviraltherapyinkenya
AT bukusielizabetha retrospectivecohortanalysiscomparingpregnancyratesamonghivpositivewomenusingcontraceptivesandefavirenzornevirapinebasedantiretroviraltherapyinkenya
AT newmannsaraj retrospectivecohortanalysiscomparingpregnancyratesamonghivpositivewomenusingcontraceptivesandefavirenzornevirapinebasedantiretroviraltherapyinkenya
AT cohencraigr retrospectivecohortanalysiscomparingpregnancyratesamonghivpositivewomenusingcontraceptivesandefavirenzornevirapinebasedantiretroviraltherapyinkenya