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Hormonal Contraception and Risk of Cardiometabolic Disease in Women with HIV

Jamison Norwood1, Cathy A Jenkins2, Manasa Bhatta3,4

  • 1Division of Infectious Disease, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Journal of Women'S Health (2002)
|March 14, 2024
PubMed

Insights

Hormonal contraception (HC) use in women with HIV showed varied cardiometabolic risks. Oral HC was linked to higher cardiovascular disease odds, while DMPA decreased metabolic disorder risks.

Area of Science:

  • Reproductive Health
  • Infectious Diseases
  • Cardiology
  • Endocrinology

Background:

  • Hormonal contraception (HC) is widely used by women living with human immunodeficiency virus (HIV).
  • The association between HC use and cardiometabolic outcomes in this population remains incompletely understood.
  • Understanding these risks is crucial for informed contraceptive choices in women with HIV.

Purpose of the Study:

  • To investigate the association between hormonal contraception use and incident cardiometabolic outcomes among women with HIV.
  • To differentiate risks associated with oral HC versus injectable HC (specifically DMPA).
  • To inform clinical decision-making regarding contraceptive selection for women with HIV.

Main Methods:

  • A cohort study of 710 women with HIV (aged 18-45) in the Southeastern US (1998-2018).
  • HC use (oral and injectable DMPA) was determined from medication records.
  • Multivariable marginal structural models analyzed associations between HC use and incident cardiovascular/thrombotic disease (CVD) and metabolic disorders, adjusting for confounders.

Main Results:

  • Oral HC use showed a non-significant trend towards increased odds of CVD.
  • Depot medroxyprogesterone acetate (DMPA) use was significantly associated with decreased odds of incident metabolic disorders (diabetes, dyslipidemia, obesity, NASH).
  • DMPA was not associated with increased CVD risk.

Conclusions:

  • Cardiovascular risk should be a key consideration when selecting contraception for women with HIV.
  • Injectable DMPA may offer a favorable metabolic profile compared to oral HC in women with HIV.
  • Further research may be warranted to confirm these findings and explore underlying mechanisms.

Keywords:
HIVcardiometabolic diseasecontraceptionwomen

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