January 26, 2015
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DMPA use increased HIV risk

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Researchers have found more evidence that the injectable progestin contraceptive depot-medroxyprogesterone acetate, or DMPA, is linked to increased risk for HIV infection.

Their findings, published in PLOS Medicine, are consistent with previous research on hormonal contraception.

“[W]omen with high HIV risk need access to additional safe and effective contraceptive options, and they need to be counseled about the relative risks and benefits of the available family planning methods,” Charles S. Morrison, PhD, senior epidemiologist at FHI 360, and colleagues wrote.

In the present study, Morrison and colleagues performed a meta-analysis of 18 prospective studies measuring hormonal contraceptive use and HIV infection among women aged 15 to 49 years in sub-Saharan Africa. The analysis included 37,124 women, 1,830 of whom became infected with HIV. The researchers evaluated HIV risk associated with combined oral contraception, DMPA and another injectable progestin, norethisterone enanthate (NET-EN).

After controlling for other risk factors, including religion, marital status, condom use, age and the number of sex partners, the researchers found that HIV acquisition was 50% more likely in women taking DMPA than women who did not use hormonal contraception. There was no significantly elevated risk for HIV infection associated with combined oral contraception or NET-EN use.

In direct comparisons of the three types of hormonal contraception, DMPA use was associated with increased HIV acquisition compared with combined oral contraception (adjusted HR=1.43, 95% CI, 1.23-1.67) and NET-EN use (aHR=1.32; 95% CI, 1.08-1.61). There was some evidence of increased HIV risk associated with NET-EN use compared with combined oral contraception (aHR=1.3; 95% CI, 0.99-1.71).

Lauren J. Ralph

In a study recently published in The Lancet Infectious Diseases, Lauren J. Ralph, MPH, an epidemiologist at the University of California at Berkeley, and colleagues conducted a systematic review and meta-analysis of peer-reviewed studies from sub-Saharan Africa on hormonal contraception exposure and incident HIV infection.

Similarly, they found that DMPA use led to a moderately increased risk for acquiring HIV (HR=1.4; 95% CI, 1.16-1.69) compared with the use of nonhormonal contraception or no contraception.

However, research presented at CROI 2013 by Summer Day, MD, resident physician in pediatrics at Seattle Children’s Hospital, and colleagues showed no evidence that hormonal contraception increased HIV infectivity in women assigned ART.

Summe Day

Summer Day

Morrison and colleagues emphasized that a randomized trial “would provide more direct evidence of the effects of different hormonal contraceptive methods, in particular DMPA, on the risk of HIV acquisition.”

For more information:

Day S. #29LB. Presented at: Conference on Retroviruses and Opportunistic Infections; March 3-6, 2013; Atlanta.

Morrison CS. PLoS Med. 2015;doi:10.1371/journal.pmed.1001778.

Ralph LJ. Lancet Infect Dis. 2015;15:181-189.

Disclosure: One of the researchers is a member of the PLOS Medicine editorial board. None of the other researchers report any relevant financial disclosures.