Hormonal contraception for women exposed to HIV infection.
BACKGROUND
Concern about a possible association of hormonal contraception with HIV acquisition has been raised by three types of evidence. Firstly, high-dose progestogen treatment greatly increases HIV acquisition in female non-human primates. Secondly, biological plausibility for a link between hormonal contraception anf HIV acquisition is provided by evidence of a hypo-oestrogenic state induced by progestogen contraception with vaginal mucosal thinning, and evidence of effects on the humoral and cellular immune systems. Thirdly, some but not other large observational studies have found an increase in HIV acquisition among women using hormonal contraception.


OBJECTIVE
To determine, from the best available evidence, the effect of hormonal contraception on HIV acquisition.


METHODS
We used the Cochrane Fertility Regulation Group trials search strategy.


METHODS
Published, unpublished and ongoing trials with random allocation, comparing hormonal with non-hormonal methods, other hormonal methods or no contraception in women at risk of HIV acquisition.


METHODS
Data will be extracted from eligible trials onto a data extraction sheet and analysed using routine Cochrane Collaboration methodology,


RESULTS
One ongoing randomised trial was identified, with no data available to date.


CONCLUSIONS
There is currently no robust evidence from randomized trials on the possible effect of hormonal contraception on HIV acquisition. High quality trials in this area are needed to inform counselling of individual woman and public health policy.
Department of Obstetrics and Gynaecology, East London Hospital Complex, University of the Witwatersrand, University of Fort Hare, Eastern Cape Department of Health, Frere and Cecilia Makiwane Hospitals, Private Bag X 9047, East London, Eastern Cape, South Africa, 5200.
G Justus
GJ
Hofmeyr
Mandisa
M
Singata
Jennifer
J
Sneden
D000328:Adult; D003267:Contraception / Q000009:adverse effects* / Q000379:methods; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage / Q000009:adverse effects*; D004967:Estrogens / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D006801:Humans; D011372:Progestins / Q000008:administration & dosage / Q000009:adverse effects
D003278:Contraceptives, Oral, Hormonal; D004967:Estrogens; D011372:Progestins