Hormonal contraceptive use, herpes simplex virus infection, and risk of HIV-1 acquisition among Kenyan women.
BACKGROUND
Studies of the effect of hormonal contraceptive use on the risk of HIV-1 acquisition have generated conflicting results. A recent study from Uganda and Zimbabwe found that women using hormonal contraception were at increased risk for HIV-1 if they were seronegative for herpes simplex virus type 2 (HSV-2), but not if they were HSV-2 seropositive.


OBJECTIVE
To explore the effect of HSV-2 infection on the relationship between hormonal contraception and HIV-1 in a high-risk population. Hormonal contraception has previously been associated with increased HIV-1 risk in this population.


METHODS
Data were from a prospective cohort study of 1206 HIV-1 seronegative sex workers from Mombasa, Kenya who were followed monthly. Multivariate Cox proportional hazards analyses were used to adjust for demographic and behavioral measures and incident sexually transmitted diseases.


RESULTS
: Two hundred and thirty-three women acquired HIV-1 (8.7/100 person-years). HSV-2 prevalence (81%) and incidence (25.4/100 person-years) were high. In multivariate analysis, including adjustment for HSV-2, HIV-1 acquisition was associated with use of oral contraceptive pills [adjusted hazard ratio (HR), 1.46; 95% confidence interval (CI), 1.00-2.13] and depot medroxyprogesterone acetate (adjusted HR, 1.73; 95% CI, 1.28-2.34). The effect of contraception on HIV-1 susceptibility did not differ significantly between HSV-2 seronegative versus seropositive women. HSV-2 infection was associated with elevated HIV-1 risk (adjusted HR, 3.58; 95% CI, 1.64-7.82).


CONCLUSIONS
In this group of high-risk African women, hormonal contraception and HSV-2 infection were both associated with increased risk for HIV-1 acquisition. HIV-1 risk associated with hormonal contraceptive use was not related to HSV-2 serostatus.
Baeten
Jared M
JM
Seattle HIV Prevention Trials Unit, Department of Medicine, University of Washington, 9012 Boren Avenue, Seattle, WA 98104, USA. jbaeten@u.washington.edu
Benki
Sarah
S
Chohan
Vrasha
V
Lavreys
Ludo
L
McClelland
R Scott
RS
Mandaliya
Kishorchandra
K
Ndinya-Achola
Jeckoniah O
JO
Jaoko
Walter
W
Overbaugh
Julie
J
D000328:Adult; D003271:Contraceptive Agents, Female / Q000009:adverse effects*; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000209:etiology* / Q000635:transmission; D015497:HIV-1; D006561:Herpes Simplex / Q000150:complications*; D018258:Herpesvirus 2, Human; D006801:Humans; D011477:Sex Work
D003271:Contraceptive Agents, Female; D003278:Contraceptives, Oral, Hormonal