Background:  The majority of the world’s 20 million HIV-infected women are of childbearing age and need access to safe and effective contraception. Animal and human studies suggest that hormonal contraception may accelerate HIV disease progression among women not yet on ART.

Methods:  We studied women enrolled in the MTCT Plus Initiative, a multi-country program of family-based HIV care and treatment. We included women who were not yet on ART, were not pregnant or at least 3 months post partum, and had documentation of exposure to contraceptive methods (hormonal or non-hormonal). HIV disease progression was defined as death, becoming eligible for ART, or a composite of the 2. We used Cox regression and categorized exposure by the method reported at the time of entry into the cohort. Since some women switched methods over time, we also performed a separate time-varying analysis where women who switched contributed person-time to each exposure category.

Results:  Between August 2002 and December 2006, 5993 women were enrolled. Of these, 3837 (64%) fit our criteria for inclusion in this analysis. At baseline 2577 of 3837 (72%) reported using no or non-hormonal contraception and 1106 of 3837 (28%) reported use of hormonal contraception. Of the latter group, 800 of 1106 (79%) used injectables or implants and 216 of 1106 (21%) used oral contraceptive pills (OCP). Risk factors for HIV disease progression were CD4 count >200 to <350 cells/mm³ (AHR 5.69, 95%CI 4.83 to 6.71) and WHO Stage II (AHR 1.52, 95%CI 1.23 to 1.88) and WHO Stage III (AHR 3.46, 95%CI 2.51 to 4.75). Exposure to hormonal contraceptives was not associated with HIV disease progression (see the table).

Conclusions:  In contrast to some other, smaller studies, this multi-country cohort analysis suggests that hormonal contraception does not accelerate HIV disease progression. While encouraging, further research is needed to examine the potential influence of individual components of contraceptive agents on disease progression.