Sexually transmitted infections and use of contraceptives in women living with HIV in Denmark: the SHADE cohort

Kristina Thorsteinsson; Steen Ladelund; Merete Storgaard; Frederikke Falkencrone Rønsholt; Isik Somuncu Johansen; Gitte Pedersen; Lars Nørregård Nielsen; Jesper Bonde; Henrik Westh; Niels Obel; Terese L Katzenstein; Anne-Mette Lebech

doi:10.1186/s12879-016-1412-7

Sexually transmitted infections and use of contraceptives in women living with HIV in Denmark: the SHADE cohort

Kristina Thorsteinsson, Steen Ladelund, Merete Storgaard, Frederikke Falkencrone Rønsholt, Isik Somuncu Johansen, Gitte Pedersen, Lars Nørregård Nielsen, Jesper Bonde, Henrik Westh, Niels Obel, Terese L Katzenstein, Anne-Mette Lebech

Department of Clinical Medicine

10 Citations (Scopus)

Abstract

BACKGROUND: No Danish guidelines for screening of sexually transmitted infections (STIs) in women living with HIV (WLWH) exist, except for annual syphilis testing. Drug-drug interaction between hormonal contraceptives and some types of highly active antiretroviral therapy (HAART) occurs. We assessed prevalence of STIs, contraceptive choices and predictors of condom use in a cohort of WLWH in Denmark.

METHODS: WLWH consecutively enrolled during their outpatient visits from 2011 to 2012. Gynaecological examination and an interview were performed at entry and 6-month follow-up. Inclusion criteria were HIV-1 infection and ≥ 18 years of age. Exclusion criteria were pregnancy, alcohol- or drug abuse impeding adherence to the protocol. At entry, participants were tested (and where appropriate, treated according to guidelines) for Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis, and herpes simplex (HSV-1 and HSV-2). At follow-up, predictors of condom use were estimated in sexually active WLWH.

RESULTS: In total, 334 of the 1,392 eligible WLWH in Denmark were included (median age and HIV duration: 42.5 and 11.3 years). Chlamydia trachomatis was present in four individuals (1 %), and six (2 %) tested positive for HSV-2 by PCR. None were positive for Neisseria gonorrhoeae, HSV-1 or had active syphilis. At follow-up, 252 (76 %) participated; 168 (70 %) were sexually active. Contraceptives were used by 124 (75 %); condoms were preferred (62 %). Having an HIV-negative partner predicted condom use (adjusted OR 3.89 (95 %CI 1.49-10.11)). In the group of participants of reproductive age without pregnancy desires 13 % used no birth-control. Possible drug-drug interaction between hormonal contraceptives and HAART was found in 13/14 WLWH receiving both kinds of medication.

CONCLUSION: The prevalence of STIs in WLWH in Denmark was low. The need for annual STI screening is questionable. Condoms were preferred contraceptives, especially in WLWH with an HIV-negative partner. In this cohort, 13 % of WLWH of reproductive age were at risk of unintended pregnancies due to lack of birth-control. Finally, in the subgroup of WLWH receiving both hormonal contraceptives and HAART possible drug-drug interactions could occur.

Original language	English
Article number	81
Journal	B M C Infectious Diseases
Volume	16
Number of pages	10
ISSN	1471-2334
DOIs	https://doi.org/10.1186/s12879-016-1412-7
Publication status	Published - 16 Feb 2016

Keywords

Journal Article
Research Support, Non-U.S. Gov't

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1186/s12879-016-1412-7Licence: CC BY

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Thorsteinsson, K., Ladelund, S., Storgaard, M., Rønsholt, F. F., Johansen, I. S., Pedersen, G., Nielsen, L. N., Bonde, J., Westh, H., Obel, N., Katzenstein, T. L., & Lebech, A.-M. (2016). Sexually transmitted infections and use of contraceptives in women living with HIV in Denmark: the SHADE cohort. B M C Infectious Diseases, 16, Article 81. https://doi.org/10.1186/s12879-016-1412-7

@article{96818c66ff3f46b6bcc462ce19d67169,

title = "Sexually transmitted infections and use of contraceptives in women living with HIV in Denmark: the SHADE cohort",

abstract = "BACKGROUND: No Danish guidelines for screening of sexually transmitted infections (STIs) in women living with HIV (WLWH) exist, except for annual syphilis testing. Drug-drug interaction between hormonal contraceptives and some types of highly active antiretroviral therapy (HAART) occurs. We assessed prevalence of STIs, contraceptive choices and predictors of condom use in a cohort of WLWH in Denmark.METHODS: WLWH consecutively enrolled during their outpatient visits from 2011 to 2012. Gynaecological examination and an interview were performed at entry and 6-month follow-up. Inclusion criteria were HIV-1 infection and ≥ 18 years of age. Exclusion criteria were pregnancy, alcohol- or drug abuse impeding adherence to the protocol. At entry, participants were tested (and where appropriate, treated according to guidelines) for Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis, and herpes simplex (HSV-1 and HSV-2). At follow-up, predictors of condom use were estimated in sexually active WLWH.RESULTS: In total, 334 of the 1,392 eligible WLWH in Denmark were included (median age and HIV duration: 42.5 and 11.3 years). Chlamydia trachomatis was present in four individuals (1 %), and six (2 %) tested positive for HSV-2 by PCR. None were positive for Neisseria gonorrhoeae, HSV-1 or had active syphilis. At follow-up, 252 (76 %) participated; 168 (70 %) were sexually active. Contraceptives were used by 124 (75 %); condoms were preferred (62 %). Having an HIV-negative partner predicted condom use (adjusted OR 3.89 (95 %CI 1.49-10.11)). In the group of participants of reproductive age without pregnancy desires 13 % used no birth-control. Possible drug-drug interaction between hormonal contraceptives and HAART was found in 13/14 WLWH receiving both kinds of medication.CONCLUSION: The prevalence of STIs in WLWH in Denmark was low. The need for annual STI screening is questionable. Condoms were preferred contraceptives, especially in WLWH with an HIV-negative partner. In this cohort, 13 % of WLWH of reproductive age were at risk of unintended pregnancies due to lack of birth-control. Finally, in the subgroup of WLWH receiving both hormonal contraceptives and HAART possible drug-drug interactions could occur.",

keywords = "Journal Article, Research Support, Non-U.S. Gov't",

author = "Kristina Thorsteinsson and Steen Ladelund and Merete Storgaard and R{\o}nsholt, {Frederikke Falkencrone} and Johansen, {Isik Somuncu} and Gitte Pedersen and Nielsen, {Lars N{\o}rreg{\aa}rd} and Jesper Bonde and Henrik Westh and Niels Obel and Katzenstein, {Terese L} and Anne-Mette Lebech",

year = "2016",

month = feb,

day = "16",

doi = "10.1186/s12879-016-1412-7",

language = "English",

volume = "16",

journal = "B M C Infectious Diseases",

issn = "1471-2334",

publisher = "BioMed Central Ltd.",

}

TY - JOUR

T1 - Sexually transmitted infections and use of contraceptives in women living with HIV in Denmark

T2 - the SHADE cohort

AU - Thorsteinsson, Kristina

AU - Ladelund, Steen

AU - Storgaard, Merete

AU - Rønsholt, Frederikke Falkencrone

AU - Johansen, Isik Somuncu

AU - Pedersen, Gitte

AU - Nielsen, Lars Nørregård

AU - Bonde, Jesper

AU - Westh, Henrik

AU - Obel, Niels

AU - Katzenstein, Terese L

AU - Lebech, Anne-Mette

PY - 2016/2/16

Y1 - 2016/2/16

N2 - BACKGROUND: No Danish guidelines for screening of sexually transmitted infections (STIs) in women living with HIV (WLWH) exist, except for annual syphilis testing. Drug-drug interaction between hormonal contraceptives and some types of highly active antiretroviral therapy (HAART) occurs. We assessed prevalence of STIs, contraceptive choices and predictors of condom use in a cohort of WLWH in Denmark.METHODS: WLWH consecutively enrolled during their outpatient visits from 2011 to 2012. Gynaecological examination and an interview were performed at entry and 6-month follow-up. Inclusion criteria were HIV-1 infection and ≥ 18 years of age. Exclusion criteria were pregnancy, alcohol- or drug abuse impeding adherence to the protocol. At entry, participants were tested (and where appropriate, treated according to guidelines) for Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis, and herpes simplex (HSV-1 and HSV-2). At follow-up, predictors of condom use were estimated in sexually active WLWH.RESULTS: In total, 334 of the 1,392 eligible WLWH in Denmark were included (median age and HIV duration: 42.5 and 11.3 years). Chlamydia trachomatis was present in four individuals (1 %), and six (2 %) tested positive for HSV-2 by PCR. None were positive for Neisseria gonorrhoeae, HSV-1 or had active syphilis. At follow-up, 252 (76 %) participated; 168 (70 %) were sexually active. Contraceptives were used by 124 (75 %); condoms were preferred (62 %). Having an HIV-negative partner predicted condom use (adjusted OR 3.89 (95 %CI 1.49-10.11)). In the group of participants of reproductive age without pregnancy desires 13 % used no birth-control. Possible drug-drug interaction between hormonal contraceptives and HAART was found in 13/14 WLWH receiving both kinds of medication.CONCLUSION: The prevalence of STIs in WLWH in Denmark was low. The need for annual STI screening is questionable. Condoms were preferred contraceptives, especially in WLWH with an HIV-negative partner. In this cohort, 13 % of WLWH of reproductive age were at risk of unintended pregnancies due to lack of birth-control. Finally, in the subgroup of WLWH receiving both hormonal contraceptives and HAART possible drug-drug interactions could occur.

AB - BACKGROUND: No Danish guidelines for screening of sexually transmitted infections (STIs) in women living with HIV (WLWH) exist, except for annual syphilis testing. Drug-drug interaction between hormonal contraceptives and some types of highly active antiretroviral therapy (HAART) occurs. We assessed prevalence of STIs, contraceptive choices and predictors of condom use in a cohort of WLWH in Denmark.METHODS: WLWH consecutively enrolled during their outpatient visits from 2011 to 2012. Gynaecological examination and an interview were performed at entry and 6-month follow-up. Inclusion criteria were HIV-1 infection and ≥ 18 years of age. Exclusion criteria were pregnancy, alcohol- or drug abuse impeding adherence to the protocol. At entry, participants were tested (and where appropriate, treated according to guidelines) for Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis, and herpes simplex (HSV-1 and HSV-2). At follow-up, predictors of condom use were estimated in sexually active WLWH.RESULTS: In total, 334 of the 1,392 eligible WLWH in Denmark were included (median age and HIV duration: 42.5 and 11.3 years). Chlamydia trachomatis was present in four individuals (1 %), and six (2 %) tested positive for HSV-2 by PCR. None were positive for Neisseria gonorrhoeae, HSV-1 or had active syphilis. At follow-up, 252 (76 %) participated; 168 (70 %) were sexually active. Contraceptives were used by 124 (75 %); condoms were preferred (62 %). Having an HIV-negative partner predicted condom use (adjusted OR 3.89 (95 %CI 1.49-10.11)). In the group of participants of reproductive age without pregnancy desires 13 % used no birth-control. Possible drug-drug interaction between hormonal contraceptives and HAART was found in 13/14 WLWH receiving both kinds of medication.CONCLUSION: The prevalence of STIs in WLWH in Denmark was low. The need for annual STI screening is questionable. Condoms were preferred contraceptives, especially in WLWH with an HIV-negative partner. In this cohort, 13 % of WLWH of reproductive age were at risk of unintended pregnancies due to lack of birth-control. Finally, in the subgroup of WLWH receiving both hormonal contraceptives and HAART possible drug-drug interactions could occur.

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

U2 - 10.1186/s12879-016-1412-7

DO - 10.1186/s12879-016-1412-7

M3 - Journal article

C2 - 26880101

SN - 1471-2334

VL - 16

JO - B M C Infectious Diseases

JF - B M C Infectious Diseases

M1 - 81

ER -

Sexually transmitted infections and use of contraceptives in women living with HIV in Denmark: the SHADE cohort

Abstract

Keywords

UN SDGs

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