Hormonal contraceptive use and female-to-male HIV transmission:  a systematic review of the epidemiologic evidence.
OBJECTIVE
To systematically review epidemiologic evidence assessing whether hormonal contraception alters the risk of HIV transmission from an HIV-positive woman to an HIV-negative male partner.


METHODS
Systematic review.


METHODS
We included articles published or in press through December 15, 2011. We assessed studies with direct evidence on hormonal contraception use and HIV transmission, and summarized studies with indirect evidence related to genital or plasma viral load.


RESULTS
: One study provided direct evidence on oral contraceptive pills (OCPs) or injectable contraception and female-to-male HIV transmission; both injectables [Cox-adjusted hazard ratio (adjHR) 1.95, 95% confidence interval (CI) 1.06-3.58; marginal structural model (MSM) adjusted odds ratio (adjOR) 3.01, 95% CI 1.47-6.16] and OCPs (Cox adjHR 2.09, 95% CI 0.75-5.84; MSM adjOR 2.35, 95% CI 0.79-6.95) generated elevated point estimates, but only estimates for injectables were significant. Findings from 11 indirect studies assessing various hormonal contraception methods and viral genital shedding or setpoint were mixed, and seven of eight studies indicated no adverse effect of various hormonal contraception methods on plasma viral load.


CONCLUSIONS
The only direct study on OCPs or injectable contraception and female-to-male HIV transmission suggests increased risk with the use of injectables. Given the potential for confounding in observational data, the paucity of direct evidence on this subject, and mixed indirect evidence, additional evidence is needed.
Office of Population and Reproductive Health, United States Agency for International Development, Washington, DC 20004, USA. cpolis@usaid.gov
Chelsea B
CB
Polis
Sharon J
SJ
Phillips
Kathryn M
KM
Curtis
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage; D004347:Drug Interactions; D019317:Evidence-Based Medicine; D005260:Female; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D008297:Male; D016017:Odds Ratio; D011247:Pregnancy; D043762:Reproductive Behavior / Q000706:statistics & numerical data*; D060728:Reproductive Health / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D019562:Viral Load / Q000706:statistics & numerical data*; D017201:Virus Shedding
D019380:Anti-HIV Agents; D003278:Contraceptives, Oral, Hormonal