title: Hormonal contraceptive methods and risk of HIV acquisition in women: a systematic review of epidemiological evidence.
abstract: Whether use of various types of hormonal contraception (HC) affect risk of HIV acquisition is a critical question for women's health. For this systematic review, we identified 22 studies published by January 15, 2014 which met inclusion criteria; we classified thirteen studies as having severe methodological limitations, and nine studies as "informative but with important limitations". Overall, data do not support an association between use of oral contraceptives and increased risk of HIV acquisition. Uncertainty persists regarding whether an association exists between depot-medroxyprogesterone acetate (DMPA) use and risk of HIV acquisition. Most studies suggested no significantly increased HIV risk with norethisterone enanthate (NET-EN) use, but when assessed in the same study, point estimates for NET-EN tended to be larger than for DMPA, though 95% confidence intervals overlapped substantially. No data have suggested significantly increased risk of HIV acquisition with use of implants, though data were limited. No data are available on the relationship between use of contraceptive patches, rings, or hormonal intrauterine devices and risk of HIV acquisition. Women choosing progestin-only injectable contraceptives such as DMPA or NET-EN should be informed of the current uncertainty regarding whether use of these methods increases risk of HIV acquisition, and like all women at risk of HIV, should be empowered to access and use condoms and other HIV preventative measures. Programs, practitioners, and women urgently need guidance on how to maximize health with respect to avoiding both unintended pregnancy and HIV given inconclusive or limited data for certain HC methods.
authors.affiliation: United States Agency for International Development (USAID), Office of Population and Reproductive Health, Washington, DC, USA, 20004; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 21205. Electronic address: cpolis@usaid.gov.
authors.forename: Chelsea B
authors.initials: CB
authors.lastname: Polis
authors.affiliation: Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland.
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Phillips
authors.affiliation: Division of Reproductive Health, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA, 30333.
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Curtis
authors.affiliation: Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA, 27599.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Westreich
authors.affiliation: Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland.
authors.forename: Petrus S
authors.initials: PS
authors.lastname: Steyn
authors.affiliation: Gynuity Health Projects, New York, NY, USA, 10010.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Raymond
authors.affiliation: Centre of Primary Academic Care, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Philip
authors.initials: P
authors.lastname: Hannaford
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Ohio State University, Columbus, OH, USA, 43210.
authors.forename: Abigail Norris
authors.initials: AN
authors.lastname: Turner
mesh_terms: D000284:Administration, Oral; D000349:Africa / Q000453:epidemiology; D017280:Condoms / Q000706:statistics & numerical data; D003271:Contraceptive Agents, Female / Q000008:administration & dosage*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D007273:Injections, Intramuscular; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage*; D009640:Norethindrone / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D003271:Contraceptive Agents, Female; D017258:Medroxyprogesterone Acetate; C024319:norethindrone enanthate; D009640:Norethindrone
keywords: DMPA; HIV acquisition; Hormonal contraception; Injectable contraception; Oral contraception; Systematic review