Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study
Renee Heffron, Deborah Donnell, Helen Rees
Connie Celum, Nelly Mugo, Edwin Were, Guy de Bruyn, Moses Joloba, Kenneth Ngure, James Kiarie, Robert W Coombs, Jared M Baeten, Partners in Prevention HSV/HIV Transmission Study Team , Edith Nakku-Joloba
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.
hormonal contraceptive HIV transmission, injectable contraceptive HIV risk, DMPA HIV-1 acquisition, oral contraceptive HIV susceptibility, hormonal contraception HIV Africa, contraceptive method HIV prevention, progestin immune suppression HIV, condom use hormonal contraception HIV, seroconversion contraceptive users, family planning HIV integration
PMID 21975269 21975269 DOI 10.1016/S1473-3099(11)70247-X 10.1016/S1473-3099(11)70247-X
Cite this article
Heffron, R., Donnell, D., Rees, H., Celum, C., Mugo, N., Were, E., de Bruyn, G., Nakku-Joloba, E., Ngure, K., Kiarie, J., Coombs, R. W., Baeten, J. M., & Partners in Prevention HSV/HIV Transmission Study Team (2012). Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study. The Lancet. Infectious diseases, 12(1), 19-26. https://doi.org/10.1016/S1473-3099(11)70247-X
Heffron R, Donnell D, Rees H, Celum C, Mugo N, Were E, et al. Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study. Lancet Infect Dis. 2012;12(1):19-26. doi:10.1016/S1473-3099(11)70247-X
Heffron, R., et al. "Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study." The Lancet. Infectious diseases, vol. 12, no. 1, 2012, pp. 19-26.
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