Progestin-only Hormonal Contraception Linked to Lower HDL Levels and More Insulin Resistance in Women with HIV

		SUMMARY: HIV positive women who use progestin-only hormonal contraception (such as injections, implants, or the "mini-pill") are more likely to have low levels of high-density lipoprotein and greater insulin resistance than women who use combined estrogen/progestin methods. These findings, published in the December 2009 Journal of Acquired Immune Deficiency Syndromes, suggest that combination contraceptive methods may be preferable for women at risk for cardiovascular disease.

By Liz Highleyman

Given that both HIV and hormonal contraceptives have been linked to metabolic abnormalities, Julie Womack from Yale University School of Nursing and colleagues investigated the link between progestin-only and estrogen/progestin combination contraceptive methods and disorders of glucose and lipid metabolism.

The study included 885 HIV positive and 408 HIV negative women from the Women's Interagency HIV Study (WIHS) seen between October 2000 and September 2005.

The investigators used linear mixed models to evaluate the association between hormonal contraception and metabolic parameters including fasting high-density lipoprotein (HDL or "good cholesterol"), low-density lipoprotein (LDL or "bad cholesterol"), triglycerides, blood glucose, and insulin resistance using the HOMA-IR method.

Results

	Compared with no hormonal contraception, progestin-only methods were independently associated with lower HDL levels, a risk factor for cardiovascular disease:
	-3 mg/dL for HIV positive women; -6 mg/dL for HIV negative women.
	Progestin-only contraception was also independently associated with greater insulin resistance (higher HOMA-IR scores):
	+0.86 for HIV positive women; +0.56 for HIV negative women.
	In contrast, combined estrogen/progestin contraception was associated with higher HDL levels, which is protective against cardiovascular disease:
	+5 mg/dL for HIV positive women; +5 mg/dL for HIV negative women.

Based on these findings, the study authors concluded, "HIV-infected women using progestin-only hormonal contraception have lower HDL and greater HOMA-IR than HIV-infected non-hormonal contraception users."

"Combined hormonal contraception may be preferred in HIV-infected women of reproductive age at risk for cardiovascular disease, but interactions with antiretroviral therapy that may impair contraceptive efficacy have been reported," they continued. "Alternative hormonal contraception methods that minimize adverse outcomes but maintain efficacy require further study."

Yale University School of Nursing, New Haven, CT.

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Reference

JA Womack, R Scherzer, SR Cole, and others. Hormonal Contraception and Metabolic Outcomes in Women With or at Risk for HIV Infection. Journal of Acquired Immune Deficiency Syndromes 52(5): 581-587 (Abstract). December 2009.