A Prospective Cohort Study of the Effect of Depot Medroxyprogesterone Acetate on Detection of Plasma and Cervical HIV-1 in Women Initiating and Continuing Antiretroviral Therapy

Day, Summer MD*; Graham, Susan M. MD, MPH, PhD*,†; Masese, Linnet N. MBChB; Richardson, Barbra A. PhD§,‖,¶; Kiarie, James N. MBChB#; Jaoko, Walter MBChB; Mandaliya, Kishorchandra MBChB**; Chohan, Vrasha BSc*,¶; Overbaugh, Julie PhD; Scott McClelland, R. MD, MPH*,†,‡,‖

JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0000000000000187
Brief Report: Epidemiology and Prevention
Abstract

Abstract: Depot medroxyprogesterone acetate (DMPA) use among HIV-1–infected women may increase transmission by increasing plasma and genital HIV-1 RNA shedding. We investigated associations between DMPA use and HIV-1 RNA in plasma and cervical secretions. One hundred two women initiated antiretroviral therapy, contributing 925 follow-up visits over a median of 34 months. Compared with visits with no hormonal contraception exposure, DMPA exposure did not increase detection of plasma (adjusted odds ratio: 0.81, 95% confidence interval: 0.47 to 1.39) or cervical HIV-1 RNA (adjusted odds ratio: 1.41, 95% confidence interval: 0.54 to 3.67). Our results suggest that DMPA is unlikely to increase infectivity in HIV-positive women who are adherent to effective antiretroviral therapy.

Author Information

*Department of Medicine, University of Washington, Seattle, WA;

Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya;

Departments of Epidemiology;

§Biostatistics;

Global Health, University of Washington, Seattle WA;

Fred Hutchinson Cancer Research Center, Seattle, WA;

#Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya; and

**Pathcare Laboratories, Mombasa, Kenya.

Correspondence to: R. Scott McClelland, MD, MPH, University of Washington, Box 359909, 325, 9th Avenue, Seattle, WA 98104 (e-mail: mcclell@uw.edu).

Presented as an oral abstract at the 20th Conference on Retroviruses and Opportunistic Infections, March 4, 2013, Atlanta, GA.

Supported by the National Institutes of Health (NIH) under award number R01AI58698 and bridge funding R56AI58698. The NIH had no role in conducting the research or in the decision to publish. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

J.O. has received reagents from Gen-Probe for HIV viral load testing. B.A.R. acts as a consultant to EMD Serono and Tobira Therapeutics Inc. The remaining authors have no conflicts of interest to disclose.

S.D., R.S.M., S.M.G., B.A.R., W.J., J.N.K., and K.M. were involved in the study conception and design. B.A.R. and S.D. performed the statistical analysis. V.C. performed and J.O. oversaw and provided equipment for the laboratory experiments. W.J., J.N.K., K.S.M., and L.N.M. oversaw the collection of clinical and laboratory data. All authors revised the manuscript and approved the final draft.

Received November 27, 2013

Accepted April 02, 2014

© 2014 by Lippincott Williams & Wilkins