Renee Heffron MPH a, Deborah Donnell PhD e f, Prof Helen Rees MBBChir g, Prof Connie Celum MD a b c, Nelly Mugo MBChB b i j, Edwin Were MBChB k, Guy de Bruyn MBBCh h, Edith Nakku-Joloba MBChB l m, Kenneth Ngure MPH i, James Kiarie MBChB b i j, Prof Robert W Coombs MD c d, Jared M Baeten MD a b c , for the Partners in Prevention HSV/HIV Transmission Study Team†

Background

Hormonal contraceptives are used widely but their effects on HIV-1 risk are unclear. We aimed to assess the association between hormonal contraceptive use and risk of HIV-1 acquisition by women and HIV-1 transmission from HIV-1-infected women to their male partners.

Methods

In this prospective study, we followed up 3790 heterosexual HIV-1-serodiscordant couples participating in two longitudinal studies of HIV-1 incidence in seven African countries. Among injectable and oral hormonal contraceptive users and non-users, we compared rates of HIV-1 acquisition by women and HIV-1 transmission from women to men. The primary outcome measure was HIV-1 seroconversion. We used Cox proportional hazards regression and marginal structural modelling to assess the effect of contraceptive use on HIV-1 risk.

Findings

Among 1314 couples in which the HIV-1-seronegative partner was female (median follow-up 18·0 [IQR 12·6—24·2] months), rates of HIV-1 acquisition were 6·61 per 100 person-years in women who used hormonal contraception and 3·78 per 100 person-years in those who did not (adjusted hazard ratio 1·98, 95% CI 1·06—3·68, p=0·03). Among 2476 couples in which the HIV-1-seronegative partner was male (median follow-up 18·7 [IQR 12·8—24·2] months), rates of HIV-1 transmission from women to men were 2·61 per 100 person-years in couples in which women used hormonal contraception and 1·51 per 100 person-years in couples in which women did not use hormonal contraception (adjusted hazard ratio 1·97, 95% CI 1·12—3·45, p=0·02). Marginal structural model analyses generated much the same results to the Cox proportional hazards regression.

Interpretation

Women should be counselled about potentially increased risk of HIV-1 acquisition and transmission with hormonal contraception, especially injectable methods, and about the importance of dual protection with condoms to decrease HIV-1 risk. Non-hormonal or low-dose hormonal contraceptive methods should be considered for women with or at-risk for HIV-1.

Funding

US National Institutes of Health and the Bill & Melinda Gates Foundation.

The Lancet Infectious Diseases, Early Online Publication, 4 October 2011

doi:10.1016/S1473-3099(11)70254-7Cite or Link Using DOI

Hormonal contraception and HIV: an unanswered question

Charles S Morrison a, Kavita Nanda a

Most of the 16 million women currently living with HIV are in sub-Saharan Africa, where 60% of HIV infections occur in women. 1 A high proportion of women in this region also use hormonal contraception, especially injectable depot-medroxyprogesterone acetate (DMPA). 2 Since the first report of increased HIV acquisition in women taking oral contraceptives, 3 whether hormonal contraception increases the risk of HIV acquisition remains a crucial unanswered question.

Depo-Provera abrogates attenuated lentivirus-induced protection in male rhesus macaques challenged intravenously with pathogenic SIVmac239. - Genescà M - J Med Primatol - 01-AUG-2007; 36(4-5): 266-75 (MEDLINE® is the source for the citation and abstract of this record )
DOI: 10.1111/j.1600-0684.2007.00244.x

BACKGROUND: Progesterone administration prior to intravaginal challenge with pathogenic SIVmac239 decreases the protective efficacy of live attenuated vaccines in rhesus macaques.

METHODS: To determine if progesterone alters the efficacy of live attenuated vaccines through local or systemic effects, seven male rhesus macaques were immunized with SHIV89.6 and then challenged intravenously with SIVmac239. Three of these animals were treated with Depo-Provera 30 days prior to the SIV challenge.

RESULTS: The SHIV animals had significantly lower plasma viral RNA levels than the unimmunized control monkeys, but the Depo-Provera treated, SHIV-immunized animals did not. Despite the lack of protection, the Depo-Provera SHIV animals had strong SIV specific T-cell responses. However, altered patterns of NK frequency and CD38 T-cell expression prior to SIV challenge were observed in Depo-Provera SHIV animals.

CONCLUSIONS: Depo-Provera eliminates live-attenuated lentivirus vaccine efficacy in male rhesus monkeys through systemic effects on antiviral immunity and/or viral replication.

 xcxxcxxc  F ” “xxxx» cont