title: Research gaps in defining the biological link between HIV risk and hormonal contraception.
abstract: Epidemiologic data suggest an association between depot medroxyprogesterone acetate (DMPA), a progesterone-based hormonal contraceptive, and increased risk of HIV acquisition and transmission. DMPA is highly effective and is among the most commonly used form of hormonal contraception in areas of high HIV prevalence. Thus, defining the biological mechanisms that contribute to the potential negative synergy between DMPA and HIV is key and may facilitate the identification of alternative contraceptive strategies. Proposed mechanisms include thinning or disruption of the cervicovaginal epithelial barrier, induction of mucosal inflammation, interference with innate and adaptive soluble and cellular immune responses, and/or alterations in the vaginal microbiome. DMPA may also indirectly increase the risk of HIV by promoting genital herpes or other sexually transmitted infections. However, there is a paucity of rigorous in vitro, animal model and clinical data to support these potential mechanisms highlighting the need for future research.
authors.affiliation: Albert Einstein College of Medicine, Bronx, NY, USA.
authors.forename: Kerry
authors.initials: K
authors.lastname: Murphy
authors.forename: Susan C
authors.initials: SC
authors.lastname: Irvin
authors.forename: Betsy C
authors.initials: BC
authors.lastname: Herold
mesh_terms: D000818:Animals; D003267:Contraception; D003271:Contraceptive Agents, Female / Q000009:adverse effects*; D005260:Female; D015658:HIV Infections / Q000276:immunology / Q000635:transmission* / Q000821:virology; D006558:Herpes Genitalis / Q000276:immunology / Q000635:transmission / Q000821:virology; D006801:Humans; D018928:Immunity, Mucosal / Q000187:drug effects*; D007365:Intercellular Junctions / Q000187:drug effects* / Q000276:immunology / Q000473:pathology / Q000821:virology; D017258:Medroxyprogesterone Acetate / Q000009:adverse effects*; D064307:Microbiota / Q000276:immunology; D009092:Mucous Membrane / Q000187:drug effects* / Q000276:immunology / Q000473:pathology / Q000821:virology; D010539:Permeability / Q000187:drug effects; D012306:Risk; D014621:Vagina / Q000276:immunology / Q000821:virology
chemical_list: D003271:Contraceptive Agents, Female; D017258:Medroxyprogesterone Acetate
keywords: Depo-Provera; HIV; female genital tract; hormonal contraception; mucosal immunity