Effect of hormonal contraception in HIV disease progressionamong HIV positive women: A study in Tehran, Iran

2^nd International Conference on HIV/AIDS, STDs, & STIs

October 27-29, 2014 Embassy Suites Las Vegas, USA

Zahra Bayat Jozani, Saeed Bayanolhagh, Zohre Rostam Afshar, Minoo Mohraz, Minoo Saatian, Sara Sardashti and Sara Ahsani Nasab

Accepted Abstracts: J AIDS Clin Res

Abstract :

Objectives: Reproductive health services including family planning programs are of prominence among HIV-infected women to reduce the risk of unintended pregnancies and mother-to-child transmission. However, the use of hormonal contraception (HC)is controversial regarding its effects on disease progressionand potential interactions with antiretroviral drugs. The increasing number of HIV-infected women and paucity of information on the potential effects of this method among Iranian women obliged us to perform the present study. Methods: In a historical cohort, demographic, medical, and reproductive profiles of allfemale HIV-infected patients enrolled in the HIV Clinic of Imam Khomeini Hospital were evaluated. Patients receiving hormonal contraceptives and usingcondoms were selected; those who had no intentions for pregnancy for at leasta year and at least 3 months post-partum, were invited to be re-evaluatedfor possible contraindications of HC use and abnormal Pap smear findings.In total, 28 patients were selected as case group and were compared with amatched control group of female patients who had consistent condom use. In six months (patients to be followed for another 6 months afterwards) HIV disease progression was monitored considering timeto a CD4 cell count below 200, time to initiation of antiretroviral therapy, anincrease in HIV-RNA viral load, significant decrease in CD4 count, and death. Results: From 50 HIV infected women with completed primary work up and follow up checklists in a 9 months period, a repeated measures ANOVA determined that the mean HIV-1-RNA plasma viral loads differed significantly between time points among patients using hormonal contraceptives (p<0.05). The mean CD4+ T-cell counts also, differed significantly between time points with an increasing trend among hormone users with dual contraception (p<0.001), while no significant changes observed among condom users (p>0.05). Mean age of our patients was 31.34 (21-51) years and mean years from confirmed diagnosis was 4years. Adherence to antiretroviral therapy (ART) has been correlated strongly with using hormonal contraceptive. The prevalence of abnormal Pap smear findings among the two groups was as follows: 16% ASCUS (atypical squamous cells of undetermined significance), 9.2% LGSIL (low-grade squamous intraepithelial lesions), and 1.3% HGSIL (high-grade squamous intraepithelial lesions). More regular menstruation cycles were reported during our follow up among patients using HC (8.7%); we had two cases of unintended pregnancy among patients only using condoms. HC discontinuation was associated with experiencing side-effects, lack of husband?s support in OC use. Adequate counseling about how to properly take HC decreases rates of discontinuation. Conclusion: Using hormonal contraception as dual protection has shown to be acceptable amongour participants. Professional counseling is essential to reduce unplanned pregnancies and hence mother-to-child transmission rates. HC has shown no significant effectson disease progression among women using antiretroviral drugs.