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Hormonal contraceptive use and female-to-male HIV transmission: a systematic review of the epidemiologic evidence

Polis, Chelsea B.; Phillips, Sharon J.; Curtis, Kathryn M.

doi: 10.1097/QAD.0b013e32835ad539
Editorial Review

Objective: To systematically review epidemiologic evidence assessing whether hormonal contraception alters the risk of HIV transmission from an HIV-positive woman to an HIV-negative male partner.

Design: Systematic review.

Methods: We included articles published or in press through December 15, 2011. We assessed studies with direct evidence on hormonal contraception use and HIV transmission, and summarized studies with indirect evidence related to genital or plasma viral load.

Results: One study provided direct evidence on oral contraceptive pills (OCPs) or injectable contraception and female-to-male HIV transmission; both injectables [Cox-adjusted hazard ratio (adjHR) 1.95, 95% confidence interval (CI) 1.06–3.58; marginal structural model (MSM) adjusted odds ratio (adjOR) 3.01, 95% CI 1.47–6.16] and OCPs (Cox adjHR 2.09, 95% CI 0.75–5.84; MSM adjOR 2.35, 95% CI 0.79–6.95) generated elevated point estimates, but only estimates for injectables were significant. Findings from 11 indirect studies assessing various hormonal contraception methods and viral genital shedding or setpoint were mixed, and seven of eight studies indicated no adverse effect of various hormonal contraception methods on plasma viral load.

Conclusion: The only direct study on OCPs or injectable contraception and female-to-male HIV transmission suggests increased risk with the use of injectables. Given the potential for confounding in observational data, the paucity of direct evidence on this subject, and mixed indirect evidence, additional evidence is needed.

aOffice of Population and Reproductive Health, United States Agency for International Development, Washington, DC, USA

bDepartment of Reproductive Health and Research, World Health Organization, Geneva, Switzerland

cDivision of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Correspondence to Chelsea B. Polis, USAID GH/PRH/RTU, 1201 Pennsylvania Ave NW, Suite 315, Washington DC, 20004, USA. Tel: +1 202 808 3800; e-mail:

Received 13 July, 2012

Revised 18 September, 2012

Accepted 27 September, 2012

Copyright © 2013 Wolters Kluwer Health, Inc.