Progestin-Only Contraception Worsens Metabolic Outcomes in Women With HIV
Progestin-only contraception worsens metabolic outcomes in women with HIV infection, according to a report in the Journal of Acquired Immune Deficiency Syndromes on December 15.
In the article, Dr. Julie A. Womack from the Department of Veterans Affairs Medical Center, West Haven, Connecticut, and colleagues observe that since hormonal contraceptives are known to be linked with metabolic dysregulation in healthy women, they are likely to be “an additional risk factor for metabolic dysfunction in HIV-infected women,” whose disease already places them at higher risk for this problem.
The study subjects were 875 HIV-infected and 406 HIV-uninfected women enrolled in the Women’s Interagency HIV Study.
In a multivariable model, progestin-only hormonal contraception was associated with lower HDL and higher insulin resistance in both groups of women, compared with no contraception or non-hormonal contraception. In contrast, combined hormonal contraception was associated with higher HDL in both groups.
Over time, among the women using progestin-only contraception, there was a small decrease in HDL in uninfected women but little change in HIV-infected women. Insulin resistance changed only very slightly over time in both groups.
Combined hormonal contraception was not associated with significant alterations in HDL over time, the authors report, and neither type of contraception was associated with significant changes in serum triglycerides, LDL, or glucose over time.
In the HIV-infected women, adding HIV-specific covariates to the model strengthened the association of progestin-only contraception with HDL and insulin resistance, but not the association between combined contraception and any metabolic measures.
Dr. Womack commented to Reuters Health that while progestin-only contraceptive methods may be associated with lower HDL and increased insulin resistance, some products – and she mentioned depot medroxyprogesterone acetate and implants in particular — are “important contraceptive options for women — HIV-infected and uninfected.”
“Providers may want to exercise more caution regarding the use of progestin-only contraception in women at risk for cardiovascular disease,” she added. “This may be more important in the setting of HIV infection, since HIV infection has been associated with low HDL and premature atherosclerosis.”