Hormonal contraception and the risk of HIV acquisition among women in South Africa
Charles Morrison, Janneke van de Wijgert, Khatija Ahmed, Pai-Lien Chen, Barbara Friedland, Cynthia Kwok, Smruti Patel, Janneke H H M van de Wijgert, Marlena Gehret-Plagianos, Pekka Lahteenmaki, Gita Ramjee, Stephanie Skoler-Karpoff
Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, University of Liverpool, Merseyside, United Kingdom.
To evaluate the effect of hormonal contraception including combined oral contraceptives (COCs), and the injectable progestins depo-medroxyprogesterone acetate (DMPA) and norethisterone enanthate (Net-En) on the risk of HIV acquisition among women in South Africa. DESIGN/
Methods
We analyzed data from 5567 women aged 16-49 years participating in the Carraguard Phase 3 Efficacy Trial. Participants were interviewed about contraceptive use and sexual behaviors and underwent pelvic examinations and HIV testing quarterly. We used marginal structural Cox regression models to estimate the effect of hormonal contraception exposure on HIV acquisition risk among women overall and among young women (16-24 years) in particular.
Results
Two hundred and seventy participants became HIV-infected (3.7 per 100 woman-years); HIV incidence was 2.8, 4.6, 3.5 and 3.4 per 100 woman-years in the COC, DMPA, Net-En and nonhormonal contraceptive groups, respectively (P = 0.09). The adjusted hazard ratios (AHRs) were 0.84 [95% confidence interval (CI) 0.51-1.39], 1.28 (95% CI 0.92-1.78) and 0.92 (95% CI 0.64-1.32) among COC, DMPA and Net-En users, respectively, compared with the nonhormonal group controlling for covariates. Age modified the effect of hormonal contraception on HIV acquisition risk; among young women, the AHRs were 1.02 (95% CI 0.46-2.28) for COCs, 1.68 (95% CI 0.96-2.94) for DMPA and 1.36 (95% CI0.78-2.35) for Net-En users.
Conclusions
In this study conducted among South African women, hormonal contraception did not significantly increase the risk of HIV acquisition. However, the effect estimate does not rule out a moderate increase in HIV risk associated with DMPA use found in some other recent studies.
hormonal contraception HIV acquisition risk South Africa, DMPA injectable progestin HIV risk women, depo-medroxyprogesterone acetate HIV incidence prospective study, combined oral contraceptives norethisterone enanthate HIV acquisition, hormonal contraception immunodeficiency virus susceptibility, Carraguard trial contraceptive use HIV incidence South Africa, marginal structural Cox regression hormonal contraception HIV, injectable progestin young women HIV risk age modification, Morrison hormonal contraception HIV acquisition epidemiology, DMPA Net-En COC HIV risk comparison nonhormonal contraception
PMID 22156973 22156973 DOI 10.1097/QAD.0b013e32834fa13d 10.1097/QAD.0b013e32834fa13d
Cite this article
Morrison, C. S., Skoler-Karpoff, S., Kwok, C., Chen, P. L., van de Wijgert, J., Gehret-Plagianos, M., Patel, S., Ahmed, K., Ramjee, G., Friedland, B., & Lahteenmaki, P. (2012). Hormonal contraception and the risk of HIV acquisition among women in South Africa. *AIDS (London, England)*, *26*(4), 497-504. https://doi.org/10.1097/QAD.0b013e32834fa13d
Morrison CS, Skoler-Karpoff S, Kwok C, Chen PL, van de Wijgert J, Gehret-Plagianos M, et al. Hormonal contraception and the risk of HIV acquisition among women in South Africa. AIDS. 2012;26(4):497-504. doi:10.1097/QAD.0b013e32834fa13d
Morrison, C. S., et al. "Hormonal contraception and the risk of HIV acquisition among women in South Africa." *AIDS (London, England)*, vol. 26, no. 4, 2012, pp. 497-504.
Background: Many women using hormonal contraceptives are also at risk of sexually transmitted HIV infection, but data are mixed on whether hormonal contraception increases women's risk of HIV. We inve...
Background: Studies of the effect of hormonal contraceptive use on the risk of HIV-1 acquisition have generated conflicting results. A recent study from Uganda and Zimbabwe found that women using horm...