Hormonal contraception and the risk of HIV acquisition.
BACKGROUND
Combined oral contraceptives (COC) and depot-medroxyprogesterone acetate (DMPA) are among the most widely used family planning methods; their effect on HIV acquisition is not known.


OBJECTIVE
To evaluate the effect of COC and DMPA on HIV acquisition and any modifying effects of other sexually transmitted infections.


METHODS
This multicenter prospective cohort study enroled 6109 HIV-uninfected women, aged 18-35 years, from family planning clinics in Uganda, Zimbabwe and Thailand. Participants received HIV testing quarterly for 15-24 months. The risk of HIV acquisition with different contraceptive methods was assessed (excluding Thailand, where there were few HIV cases).


RESULTS
HIV infection occurred in 213 African participants (2.8/100 woman-years). Use of neither COC [hazard ratio (HR), 0.99; 95% confidence interval (CI), 0.69-1.42] nor DMPA (HR, 1.25; 95% CI, 0.89-1.78) was associated with risk of HIV acquisition overall, including among participants with cervical or vaginal infections. While absolute risk of HIV acquisition was higher among participants who were seropositive for herpes simplex virus 2 (HSV-2) than in those seronegative at enrolment, among the HSV-2-seronegative participants, both COC (HR, 2.85; 95% CI, 1.39-5.82) and DMPA (HR, 3.97; 95% CI, 1.98-8.00) users had an increased risk of HIV acquisition compared with the non-hormonal group.


CONCLUSIONS
No association was found between hormonal contraceptive use and HIV acquisition overall. This is reassuring for women needing effective contraception in settings of high HIV prevalence. However, hormonal contraceptive users who were HSV-2 seronegative had an increased risk of HIV acquisition. Additional research is needed to confirm and explain this finding.
Morrison
Charles S
CS
Clinical Research Department, Family Health International, Research Triangle Park, North Carolina, USA. cmorrison@fhi.org
Richardson
Barbra A
BA
Mmiro
Francis
F
Chipato
Tsungai
T
Celentano
David D
DD
Luoto
Joanne
J
Mugerwa
Roy
R
Padian
Nancy
N
Rugpao
Sungwal
S
Brown
Joelle M
JM
Cornelisse
Peter
P
Salata
Robert A
RA
D000328:Adult; D016001:Confidence Intervals; D003268:Contraception Behavior; D003278:Contraceptives, Oral, Hormonal; D003692:Delayed-Action Preparations; D018562:Disease Transmission, Infectious; D005260:Female; D006678:HIV; D015658:HIV Infections / Q000635:transmission* / Q000821:virology; D006561:Herpes Simplex / Q000150:complications; D018258:Herpesvirus 2, Human; D006801:Humans; D008297:Male; D017258:Medroxyprogesterone Acetate; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D013785:Thailand; D014454:Uganda; D015030:Zimbabwe
D003278:Contraceptives, Oral, Hormonal; D003692:Delayed-Action Preparations; D017258:Medroxyprogesterone Acetate