Effect of Hormonal Contraceptive Use Before HIV Seroconversion on Viral Load Setpoint Among Women in Rakai, Uganda

Background: High viral load (VL) setpoint is a marker for rapid HIV progression. Few studies have examined whether use of hormonal contraception (HC) prior to HIV seroconversion affects VL setpoint. Methods: We determined VL setpoints in 285 HIV seroconverters using blood samples collected 6 months or more after estimated HIV seroconversion but before disease progression to CD4 <= 250 or WHO Stage 3 or 4. We used multivariate linear regression to estimate the effect of HC use before HIV seroconversion on VL setpoint, and multivariate Cox regression to estimate the hazards ratio of death associated with VL setpoint. Results: Of 285 women, 42 (15%) reported using HC before HIV seroconversion. Mean VL setpoint was 4.49 (SD 0.79) log(10) copies per milliliter among women who used HC before HIV seroconversion and 4.47 (SD 0.86) among non-HC users (P = 0.88). In multivariate analysis, HC before HIV seroconversion was not associated with VL setpoint (+0.11 log(10) copies/mL; P = 0.47). Higher socioeconomic status was associated with lower VL setpoint (-0.43 log(10) copies/mL; P = 0.04). VL setpoints above the median were associated with faster time to death (adjHR: 2.54, 95% confidence interval: 1.30 to 4.98, P < 0.01). Conclusions: Use of HC before HIV seroconversion was not associated with elevated VL setpoint.