Oral & Injectable Contraceptive Use & HIV Acquisition Risk among Women in 4 African Countries: A Secondary Analysis of Data from a Microbicide Trial

To assess the effect of oral and injectable contraceptive use compared to non-hormonal contraceptive use on HIV acquisition among Southern African women enrolled in a microbicide trial.

Prospective cohort study using data from women enrolled in HIV Prevention Trials Network (HPTN) protocol 035. At each quarterly visit, participants were interviewed about self-reported contraceptive use and sexual behaviors and underwent HIV testing. Cox proportional hazards regression was used to assess the effect of injectable and oral hormonal contraceptive use on HIV acquisition.

The analysis included 2,830 participants, of whom 106 became HIV infected (4.07 per 100 person-years.) At baseline, 1,546 (51%) participants reported using injectable contraceptives and 595 (21%) reported using oral contraceptives. HIV incidence among injectable, oral and non-hormonal contraceptive method users was: 4.72, 2.68 and 3.83 per 100 person-years, respectively. Injectable contraceptive use was associated with a non-statistically significant increased risk of HIV acquisition (adjusted hazard ratio [aHR]=1.17; 95% confidence interval [CI] 0.70, 1.96), while oral contraceptive use was associated with a non-statistically significant decreased risk of HIV acquisition (aHR=0.76; 95% CI 0.37,1.55).

In this secondary analysis of randomized trial data, a marginal, but non-statistically significant, increase in HIV risk among women using injectable hormonal contraceptives was observed. No increased HIV risk was observed among women using oral contraceptives. Our findings support the World Health Organization's recommendation that women at high risk for acquiring HIV, including those using progestogen-only injectable contraception, should be strongly advised to always use condoms and other HIV prevention measures.

Among Southern African women participating in an HIV prevention trial, women using injectable hormonal contraceptives had a modest increased risk of HIV acquisition, however this association was not statistically significant. Continued research on the relationship between widely used hormonal contraceptive methods and HIV acquisition is essential.

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By: Balkus JE1, Brown ER2, Hillier SL3, Coletti A4, Ramjee G5, Mgodi N6, Makanani B7, Reid C8, Martinson F9, Soto-Torres L10, Abdool Karim SS11, Chirenje ZM6.

¹Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. Electronic address: jbalkus@fhcrc.org.

²Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.

³University of Pittsburgh School of Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences and the Magee-Women's Research Institute, Pittsburgh, PA, USA.

⁴FHI360, Durham, NC, USA.

⁵HIV Prevention Research Unit, South Africa Medical Research Council, Durban, South Africa.

⁶University of Zimbabwe - University of California San Francisco Research Program, Harare, Zimbabwe.

⁷College of Medicine, University of Malawi, Blantyre, Malawi.

⁸Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.

⁹University of North Carolina Project, Kamuzu Central Hospital, Lilongwe, Malawi.

¹⁰National Institutes of Health, Bethesda, MD, USA.

¹¹Centre for the AIDS Program of Research in South Africa, Doris Duke Medical Research Institute, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Congella, South Africa; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.

 

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