title: Critical Review: Mechanisms of HIV Transmission in Depo-Provera Users: The Likely Role of Hypoestrogenism.
abstract: Almost half of new HIV infections worldwide occur in women, and vaginal intercourse is the most common mode of transmission. Accumulating evidence suggests that depot medroxyprogesterone acetate may increase HIV transmission, but little is known about the underlying mechanisms. We propose that hypoestrogenism in depot medroxyprogesterone acetate may contribute to increased HIV transmission. We present supportive evidence and propose potential interventions to prevent or treat vaginal hypoestrogenism using vaginal estrogens.
authors.affiliation: *Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia and the Royal Women's Hospital, Victoria, Australia;†Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia;‡Department of Microbiology, Monash University, Clayton, Victoria, Australia;§Department of Infectious Diseases, Monash University, Melbourne, Victoria, Australia; and‖Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Parkville, Victoria, Australia.
authors.forename: Martha
authors.initials: M
authors.lastname: Hickey
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Marino
authors.forename: Gilda
authors.initials: G
authors.lastname: Tachedjian
mesh_terms: D003271:Contraceptive Agents, Female / Q000009:adverse effects* / Q000494:pharmacology; D004967:Estrogens / Q000172:deficiency*; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000009:adverse effects* / Q000494:pharmacology; D014621:Vagina / Q000187:drug effects*
chemical_list: D003271:Contraceptive Agents, Female; D004967:Estrogens; D017258:Medroxyprogesterone Acetate