Effect of Hormonal Contraceptive Use on Virologic Response to Antiretroviral Therapy among Women in Rakai, Uganda


Author(s): Polis CB, Nakigozi G, Ssempijja V, Makumbi FE, Boaz I, Reynolds SJ, Ndyanabo A, Lutalo T, Wawer MJ, Gray RH

Year: 2011


An updated version of this paper is available online at the international reproductive health journal Contraception at the link provided below.


Objective: Effective contraceptive counseling for HIV-infected women on antiretroviral therapy (ART) is complicated by the fact that little is known about potential interactions between hormonal contraception (HC) and ART, which share common hepatic metabolic pathways.  In theory, these drugs may interact to decrease ART efficacy, decrease HC efficacy, or increase side effects.  Decreased ARV drug levels could lead to drug resistance, treatment failure, and potentially increased mortality.  In addition, regimen complexity or pill burden may contribute to non-adherence of either ART or HC regimens, and could thus lower efficacy of either regimen.  Our objective was to strengthen the evidence base regarding the effect of HC on virologic response to ART among HIV+ women in Rakai, Uganda.

Design: Retrospective analysis of clinical and questionnaire data from 433 Ugandan women initiating ART.

Methods: Using a modified Poisson regression model, we assessed the effect of HC on failure to suppress viral load at 12 months after ART initiation or ART regimen change or death within one year of ART initiation among sexually active women in Rakai, Uganda.  We also assessed whether HC use was associated with poorer adherence to ART. 

Results: We did not find that HC use was associated with increased risk of failure, nor did we find that HC use was associated with poorer adherence to ART.  

Conclusions: Our results are consistent with current WHO recommendations for HC use among HIV+ women on ART.