Hormonal contraception and the risk of HIV acquisition

BACKGROUND: Combined oral contraceptives (COC) and depot- medroxyprogesterone acetate (DMPA) are among the most widely used family planning methods; their effect on HIV acquisition is not known. OBJECTIVE: To evaluate the effect of COC and DMPA on HIV acquisition and any modifying effects of other s...

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Main Authors: Charles S. Morrison, Barbra A. Richardson, Francis Mmiro, Tsungai Chipato, David D. Celentano, Joanne Luoto, Roy Mugerwa, Nancy Padian, Sungwal Rugpao, Joelle M. Brown, Peter Cornelisse, Robert A. Salata
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Published: 2018
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http://cmuir.cmu.ac.th/jspui/handle/6653943832/61153
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spelling th-cmuir.6653943832-611532018-09-10T04:09:19Z Hormonal contraception and the risk of HIV acquisition Charles S. Morrison Barbra A. Richardson Francis Mmiro Tsungai Chipato David D. Celentano Joanne Luoto Roy Mugerwa Nancy Padian Sungwal Rugpao Joelle M. Brown Peter Cornelisse Robert A. Salata Immunology and Microbiology Medicine BACKGROUND: Combined oral contraceptives (COC) and depot- medroxyprogesterone acetate (DMPA) are among the most widely used family planning methods; their effect on HIV acquisition is not known. OBJECTIVE: To evaluate the effect of COC and DMPA on HIV acquisition and any modifying effects of other sexually transmitted infections. METHODS: This multicenter prospective cohort study enroled 6109 HIV-uninfected women, aged 18-35 years, from family planning clinics in Uganda, Zimbabwe and Thailand. Participants received HIV testing quarterly for 15-24 months. The risk of HIV acquisition with different contraceptive methods was assessed (excluding Thailand, where there were few HIV cases). RESULTS: HIV infection occurred in 213 African participants (2.8/100 woman-years). Use of neither COC [hazard ratio (HR), 0.99; 95% confidence interval (CI), 0.69-1.42] nor DMPA (HR, 1.25; 95% CI, 0.89-1.78) was associated with risk of HIV acquisition overall, including among participants with cervical or vaginal infections. While absolute risk of HIV acquisition was higher among participants who were seropositive for herpes simplex virus 2 (HSV-2) than in those seronegative at enrolment, among the HSV-2-seronegative participants, both COC (HR, 2.85; 95% CI, 1.39-5.82) and DMPA (HR, 3.97; 95% CI, 1.98-8.00) users had an increased risk of HIV acquisition compared with the non-hormonal group. CONCLUSIONS: No association was found between hormonal contraceptive use and HIV acquisition overall. This is reassuring for women needing effective contraception in settings of high HIV prevalence. However, hormonal contraceptive users who were HSV-2 seronegative had an increased risk of HIV acquisition. Additional research is needed to confirm and explain this finding. © 2007 Lippincott Williams & Wilkins, Inc. 2018-09-10T04:05:38Z 2018-09-10T04:05:38Z 2007-01-01 Journal 02699370 2-s2.0-33845486100 10.1097/QAD.0b013e3280117c8b https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=33845486100&origin=inward http://cmuir.cmu.ac.th/jspui/handle/6653943832/61153
institution Chiang Mai University
building Chiang Mai University Library
country Thailand
collection CMU Intellectual Repository
topic Immunology and Microbiology
Medicine
spellingShingle Immunology and Microbiology
Medicine
Charles S. Morrison
Barbra A. Richardson
Francis Mmiro
Tsungai Chipato
David D. Celentano
Joanne Luoto
Roy Mugerwa
Nancy Padian
Sungwal Rugpao
Joelle M. Brown
Peter Cornelisse
Robert A. Salata
Hormonal contraception and the risk of HIV acquisition
description BACKGROUND: Combined oral contraceptives (COC) and depot- medroxyprogesterone acetate (DMPA) are among the most widely used family planning methods; their effect on HIV acquisition is not known. OBJECTIVE: To evaluate the effect of COC and DMPA on HIV acquisition and any modifying effects of other sexually transmitted infections. METHODS: This multicenter prospective cohort study enroled 6109 HIV-uninfected women, aged 18-35 years, from family planning clinics in Uganda, Zimbabwe and Thailand. Participants received HIV testing quarterly for 15-24 months. The risk of HIV acquisition with different contraceptive methods was assessed (excluding Thailand, where there were few HIV cases). RESULTS: HIV infection occurred in 213 African participants (2.8/100 woman-years). Use of neither COC [hazard ratio (HR), 0.99; 95% confidence interval (CI), 0.69-1.42] nor DMPA (HR, 1.25; 95% CI, 0.89-1.78) was associated with risk of HIV acquisition overall, including among participants with cervical or vaginal infections. While absolute risk of HIV acquisition was higher among participants who were seropositive for herpes simplex virus 2 (HSV-2) than in those seronegative at enrolment, among the HSV-2-seronegative participants, both COC (HR, 2.85; 95% CI, 1.39-5.82) and DMPA (HR, 3.97; 95% CI, 1.98-8.00) users had an increased risk of HIV acquisition compared with the non-hormonal group. CONCLUSIONS: No association was found between hormonal contraceptive use and HIV acquisition overall. This is reassuring for women needing effective contraception in settings of high HIV prevalence. However, hormonal contraceptive users who were HSV-2 seronegative had an increased risk of HIV acquisition. Additional research is needed to confirm and explain this finding. © 2007 Lippincott Williams & Wilkins, Inc.
format Journal
author Charles S. Morrison
Barbra A. Richardson
Francis Mmiro
Tsungai Chipato
David D. Celentano
Joanne Luoto
Roy Mugerwa
Nancy Padian
Sungwal Rugpao
Joelle M. Brown
Peter Cornelisse
Robert A. Salata
author_facet Charles S. Morrison
Barbra A. Richardson
Francis Mmiro
Tsungai Chipato
David D. Celentano
Joanne Luoto
Roy Mugerwa
Nancy Padian
Sungwal Rugpao
Joelle M. Brown
Peter Cornelisse
Robert A. Salata
author_sort Charles S. Morrison
title Hormonal contraception and the risk of HIV acquisition
title_short Hormonal contraception and the risk of HIV acquisition
title_full Hormonal contraception and the risk of HIV acquisition
title_fullStr Hormonal contraception and the risk of HIV acquisition
title_full_unstemmed Hormonal contraception and the risk of HIV acquisition
title_sort hormonal contraception and the risk of hiv acquisition
publishDate 2018
url https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=33845486100&origin=inward
http://cmuir.cmu.ac.th/jspui/handle/6653943832/61153
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