Limited data exist on the effects of contraceptives on HIV disease progression. We studied the association between intramuscular injectable depot medroxyprogesterone acetate (DMPA-IM), the copper intrauterine device (IUD), and the levonorgestrel (LNG) implant on markers of HIV disease progression at the time of HIV detection and 3 months postdetection and time from detection to CD4 count <350 cells/mm³. Among women initiating antiretroviral therapy (ART), we studied the effect of contraceptive group on time from ART initiation to viral load (VL) <40 copies/mL. We included women 16–35 years randomized to DMPA-IM, copper IUD, or LNG implant with incident HIV infection during the Evidence for Contraceptive Options and HIV Outcomes (ECHO) trial (n = 382). We analyzed HIV VL and CD4 cell count according to participants' randomized method and also conducted a “continuous use” analysis that excluded follow-up time after method discontinuation. We used adjusted linear models to compare mean VL and CD4 cell levels by contraceptive group up to the time of ART initiation. We compared time from HIV detection to CD4 count <350 cells/mm³ and, following ART initiation, time to viral suppression (VL <40 copies/mL) using Cox proportional hazards models. At HIV detection, women allocated to DMPA-IM had lower VL relative to copper IUD (−0.28 log₁₀ copies/mL; 95% confidence interval [CI]: −0.55 to −0.01) and LNG implant (−0.27, CI: −0.55 to 0.02) and higher mean CD4 than copper IUD users by 66 cells/mm³ (CI: 11–121). In continuous use analyses women allocated to DMPA-IM progressed to CD4 < 350 cells/mm³ slower than copper IUD users (hazard ratio [HR] = 0.6, CI: 0.3–1.1), whereas copper IUD users progressed faster than LNG implant users (HR = 1.8, CI: 1.0–3.3). Time to viral suppression was faster for DMPA-IM than copper IUD (HR = 1.5, CI: 1.0–2.3) and LNG implant 1.4 (CI: 0.9–2.2) users. We found no evidence of more rapid early HIV disease progression among women using DMPA-IM than among women using copper IUD or LNG implant. Our finding of more rapid progression among copper IUD compared with DMPA-IM users should be interpreted cautiously.

中文翻译：

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醋酸甲羟孕酮，子宫内铜器和左炔诺孕酮植入物对早期HIV疾病进展的影响。

关于避孕药对艾滋病毒疾病进展的影响的数据有限。我们研究了肌内注射贮库醋酸甲羟孕酮（DMPA-IM），子宫内铜器（IUD）和左炔诺孕酮（LNG）植入物在HIV检测时，检测后3个月以及从检测到CD4计数<350细胞/ mm ³。在开始抗逆转录病毒治疗（ART）的女性中，我们研究了避孕组对从开始ART到病毒载量（VL）<40拷贝/ mL的时间的影响。我们包括妇女16-35年的证据避孕方法和HIV成果中随机到DMPA-IM，铜IUD，或与事件HIV感染LNG植入物（ECHO）试验（ñ = 382）。我们根据参与者的随机方法分析了HIV VL和CD4细胞计数，并进行了“连续使用”分析，排除了方法终止后的随访时间。我们使用调整后的线性模型比较了避孕药组直至开始ART之前的平均VL和CD4细胞水平。我们比较了从HIV检测到CD4计数<350细胞/ mm ^3的时间，以及在ART引发后使用Cox比例风险模型进行病毒抑制的时间（VL <40拷贝/ mL）。在检测到HIV时，分配给DMPA-IM的女性相对于铜制IUD（-0.28 log ₁₀拷贝/ mL； 95％置信区间[CI]：-0.55至-0.01）和LNG植入物（-0.27，CI：- 0.55至0.02）且平均CD4比铜IUD用户高66个/ mm ³（CI：11–121）。在连续使用分析中，分配给DMPA-IM的女性的CD4 <350细胞/ mm ^3的速度比铜制宫内节育器使用者慢（危险比[HR] = 0.6，CI：0.3–1.1），而铜制宫内节育器使用者的进展快于LNG植入使用者。 （HR = 1.8，CI：1.0-3.3）。DMPA-IM的病毒抑制时间要比铜制IUD（HR = 1.5，CI：1.0-2.3）和LNG植入物1.4（CI：0.9-2.2）使用者快。我们发现没有证据表明使用DMPA-IM的女性比使用铜制IUD或LNG植入的女性早期HIV疾病发展更快。我们发现，与DMPA-IM用户相比，我们发现铜制宫内节育器有更快的发展趋势，应谨慎对待。