Hormonal contraception and the risk of HIV acquisition

Morrison, Charles Sa; Richardson, Barbra Ab; Mmiro, Francisd; Chipato, Tsungaie; Celentano, David Df; Luoto, Joanneg; Mugerwa, Royd; Padian, Nancyh; Rugpao, Sungwali; Brown, Joelle Mh; Cornelisse, Peterc; Salata, Robert Aj; for the Hormonal Contraception and the Risk of HIV Acquisition (HC-HIV) Study Group

AIDS:
doi: 10.1097/QAD.0b013e3280117c8b
Epidemiology and Social
Abstract

Background: Combined oral contraceptives (COC) and depot-medroxyprogesterone acetate (DMPA) are among the most widely used family planning methods; their effect on HIV acquisition is not known.

Objective: To evaluate the effect of COC and DMPA on HIV acquisition and any modifying effects of other sexually transmitted infections.

Methods: This multicenter prospective cohort study enroled 6109 HIV-uninfected women, aged 18–35 years, from family planning clinics in Uganda, Zimbabwe and Thailand. Participants received HIV testing quarterly for 15–24 months. The risk of HIV acquisition with different contraceptive methods was assessed (excluding Thailand, where there were few HIV cases).

Results: HIV infection occurred in 213 African participants (2.8/100 woman-years). Use of neither COC [hazard ratio (HR), 0.99; 95% confidence interval (CI), 0.69–1.42] nor DMPA (HR, 1.25; 95% CI, 0.89–1.78) was associated with risk of HIV acquisition overall, including among participants with cervical or vaginal infections. While absolute risk of HIV acquisition was higher among participants who were seropositive for herpes simplex virus 2 (HSV-2) than in those seronegative at enrolment, among the HSV-2-seronegative participants, both COC (HR, 2.85; 95% CI, 1.39–5.82) and DMPA (HR, 3.97; 95% CI, 1.98–8.00) users had an increased risk of HIV acquisition compared with the non-hormonal group.

Conclusions: No association was found between hormonal contraceptive use and HIV acquisition overall. This is reassuring for women needing effective contraception in settings of high HIV prevalence. However, hormonal contraceptive users who were HSV-2 seronegative had an increased risk of HIV acquisition. Additional research is needed to confirm and explain this finding.

Author Information

From the aClinical Research Department, Family Health International, Research Triangle Park, North Carolina, USA

bDepartment of Biostatistics, University of Washington and the Statistical Center for HIV/AIDS Research & Prevention (SCHARP), Fred Hutchinson Cancer Research Center and the

cStatistical Analysis Unit, Cystic Fibrosis Therapeutics Development Network, Children's Hospital and Regional Medical Center, Seattle, Washington, USA

dFaculty of Medicine, Makerere University, Kampala, Uganda

eDepartment of Obstetrics and Gynecology, University of Zimbabwe, Harare, Zimbabwe

fDepartment of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA

gNational Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, USA

hDepartment of Obstetrics, Gynecology and Reproductive Sciences, University of California at San Francisco, San Francisco, California, USA

iResearch Institute for Health Sciences (RIHES), Chiang Mai University, Chiang Mai, Thailand

jDepartment of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.

*See the Appendix for members of the study group.

Received 22 March, 2006

Accepted 24 August, 2006

Correspondence to Dr C.S. Morrison, Family Health International, PO Box 13950, Research Triangle Park, NC 27709, USA. E-mail: cmorrison@fhi.org

© 2007 Lippincott Williams & Wilkins, Inc.