title: Hormonal contraceptive use, herpes simplex virus infection, and risk of HIV-1 acquisition among Kenyan women.
abstract: 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.
authors: Seattle HIV Prevention Trials Unit, Department of Medicine, University of Washington, 9012 Boren Avenue, Seattle, WA 98104, USA. jbaeten@u.washington.edu
authors: Jared M
authors: JM
authors: Baeten
authors: Sarah
authors: S
authors: Benki
authors: Vrasha
authors: V
authors: Chohan
authors: Ludo
authors: L
authors: Lavreys
authors: R Scott
authors: RS
authors: McClelland
authors: Kishorchandra
authors: K
authors: Mandaliya
authors: Jeckoniah O
authors: JO
authors: Ndinya-Achola
authors: Walter
authors: W
authors: Jaoko
authors: Julie
authors: J
authors: Overbaugh
mesh_terms: 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
chemical_list: D003271:Contraceptive Agents, Female; D003278:Contraceptives, Oral, Hormonal