title: Injectable Progestin-Only Contraception is Associated With Increased Levels of Pro-Inflammatory Cytokines in the Female Genital Tract.
abstract: OBJECTIVE
  Genital inflammatory changes may be a mechanism of increased HIV risk among injectable progestin-only contraception (IPC) users.
  
  
  METHODS
  We conducted a cross-sectional analysis of 376 Kenyan and South African women. Genital cytokines and secretory leukocyte peptidase inhibitor concentrations in a reference population were compared to IPC users and women with reproductive tract infections.
  
  
  RESULTS
  No significant variability in marker concentrations was observed by age or site. Depot medroxyprogesterone acetate (DMPA) users had significantly higher MIP-1α, MIP-1β, IL-6, IL-8, IP-10, and RANTES concentrations. Norethisterone oenanthate users had significantly higher IL-6, IL-8, and RANTES concentrations. Women with sexually transmitted infections had variable inflammation, and women with bacterial vaginosis exhibited a mixed profile of up and downregulation.
  
  
  CONCLUSIONS
  The finding of substantial mucosal inflammation among DMPA users provides evidence which, combined with the results of prior studies, suggests that DMPA may create an immune environment conducive to HIV target cell recruitment and inhibitory for antiviral activity.
authors.affiliation: FHI 360, Durham, NC, USA.|Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Deese
authors.affiliation: Division of Medical Virology, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa.|Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa.
authors.forename: Lindi
authors.initials: L
authors.lastname: Masson
authors.affiliation: Division of Infectious Diseases, Department of Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: William
authors.initials: W
authors.lastname: Miller
authors.affiliation: Division of Infectious Diseases, Department of Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Myron
authors.initials: M
authors.lastname: Cohen
authors.affiliation: FHI 360, Durham, NC, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Morrison
authors.affiliation: CROS NT LLC, Chapel Hill, NC, USA.
authors.forename: Meng
authors.initials: M
authors.lastname: Wang
authors.affiliation: Setshaba Research Centre, Soshanguve, Pretoria, South Africa.
authors.forename: Khatija
authors.initials: K
authors.lastname: Ahmed
authors.affiliation: Impact Research and Development Organization, Kisumu, Kenya.
authors.forename: Kawango
authors.initials: K
authors.lastname: Agot
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Tania
authors.initials: T
authors.lastname: Crucitti
authors.affiliation: Institute of Tropical Medicine, Antwerp, Belgium.
authors.forename: Saïd
authors.initials: S
authors.lastname: Abdellati
authors.affiliation: The Bill & Melinda Gates Foundation, Seattle, WA, USA.
authors.forename: Lut
authors.initials: L
authors.lastname: Van Damme
mesh_terms: D000293:Adolescent; D000328:Adult; D003267:Contraception / Q000379:methods; D003271:Contraceptive Agents, Female / Q000494:pharmacology*; D003430:Cross-Sectional Studies; D016207:Cytokines / Q000378:metabolism*; D005260:Female; D005836:Genitalia, Female / Q000378:metabolism*; D015658:HIV Infections / Q000473:pathology / Q000821:virology; D006801:Humans; D007249:Inflammation / Q000139:chemically induced; D007630:Kenya; D017258:Medroxyprogesterone Acetate / Q000494:pharmacology; D009640:Norethindrone / Q000031:analogs & derivatives / Q000494:pharmacology; D011247:Pregnancy; D011372:Progestins / Q000494:pharmacology*; D015231:Sexually Transmitted Diseases, Bacterial / Q000276:immunology* / Q000382:microbiology; D013019:South Africa; D016585:Vaginosis, Bacterial / Q000276:immunology* / Q000382:microbiology; D055815:Young Adult
chemical_list: D003271:Contraceptive Agents, Female; D016207:Cytokines; D011372:Progestins; D017258:Medroxyprogesterone Acetate; C024319:norethindrone enanthate; D009640:Norethindrone
keywords: Cytokines; depot medroxyprogesterone acetate; mucosal; secretory leukocyte peptidase inhibitor; sexually transmitted infections