Risk of HIV infection in oral contraceptive pill users: a meta-analysis.
OBJECTIVE
To review the literature and present a summary estimate of the association between HIV-1 acquisition or HIV-1 serostatus and oral contraceptives.


METHODS
MEDLINE database (January 1986-October 1997), AIDSLINE database (January 1980-October 1997), bibliographies of identified articles, and experts in the field of heterosexual HIV transmission.


METHODS
In all, 591 articles were examined. Twenty-eight studies provided adequate data to calculate a risk estimate for the association of HIV-1 serostatus or HIV-1 seroconversion with oral contraceptives and were selected for inclusion.


RESULTS
The overall summary odds ratio (OR) for the association between seroprevalent or seroincident HIV-1 infection and use of oral contraceptives in the 28 studies was 1.19 (95% confidence interval [CI], 0.99-1.42). The summary OR for 21 cross-sectional studies was 1.21 (95% CI, 1.01-1.44), whereas the summary relative risk for seven prospective studies was 1.32 (95% CI, 1.12-1.57). Study quality was assessed by applying a scale reflecting study design, measurement of exposure, ability to assess confounding, and publication status. The summary OR for the eight best studies was 1.60 (95% CI, 1.05-2.44). When analysis was limited to studies conducted in Africa, the summary OR was 1.45 (95% CI, 1.15-1.83) for the 14 studies overall, and 1.65 (95% CI, 1.09-2.52) for the seven best studies.


CONCLUSIONS
This meta-analysis found a significant association between oral contraceptive use and HIV-1 seroprevalence or seroincidence. For women at risk of HIV-1 infection, oral contraceptive use for prevention of pregnancy should be accompanied by condom use for prevention of HIV-1 infection.
Wang
C C
CC
Department of Medicine, University of Washington, Seattle 98104-2499, USA. chiaw@u.washington.edu
Reilly
M
M
Kreiss
J K
JK
D015986:Confounding Factors, Epidemiologic; D003276:Contraceptives, Oral / Q000009:adverse effects*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000209:etiology; D015528:HIV Seroprevalence; D015497:HIV-1; D006801:Humans; D015994:Incidence; D016017:Odds Ratio; D012107:Research Design / Q000592:standards; D012307:Risk Factors; D012725:Sexual Behavior
D003276:Contraceptives, Oral