Hormonal contraception and HIV acquisition among women: an updated systematic review

Curtis, Kathryn M.; Hannaford, Philip Christopher; Rodríguez, María I.; Chipato, Tsungai; Steyn, Petrus S.; Kiarie, James

doi:10.1136/bmjsrh-2019-200509

Cited by 29 publications

(31 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Omics analyses of human mucosal samples have suggested DMPA may alter vaginal epithelial repair pathways at a molecular level, which may impact epithelial permeability [ 29 , 30 ]. While observational studies have linked DMPA usage with increased HIV acquisition risk in women [ 31 – 33 ], the Evidence for Contraceptive Options and HIV Outcomes trial was designed to better assess this question, and showed no significant increase in HIV acquisition risk between DMPA, copper IUD, and LNG implant [ 34 ]. While the ECHO trial supported the safety profile of DMPA, interactions between hormonal contraceptives and mucosal immunology are still not fully understood.…”

Section: Introductionmentioning

confidence: 99%

Vaginal microbiome-hormonal contraceptive interactions associate with the mucosal proteome and HIV acquisition

et al. 2020

View full text Add to dashboard Cite

Alterations to the mucosal environment of the female genital tract, such as genital inflammation, have been associated with increased HIV acquisition in women. As the microbiome and hormonal contraceptives can affect vaginal mucosal immunity, we hypothesized these components may interact in the context of HIV susceptibility. Using previously published microbiome data from 685 women in the CAPRISA-004 trial, we compared relative risk of HIV acquisition in this cohort who were using injectable depot medroxyprogesterone acetate (DMPA), norethisterone enanthate (NET-EN), and combined oral contraceptives (COC). In women who were Lactobacillus-dominant, HIV acquisition was 3-fold higher in women using DMPA relative to women using NET-EN or COC (OR: 3.27; 95% CI: 1.24–11.24, P = 0.0305). This was not observed in non-Lactobacillus-dominant women (OR: 0.95, 95% CI: 0.44–2.15, P = 0.895) (interaction P = 0.0686). Higher serum MPA levels associated with increased molecular pathways of inflammation in the vaginal mucosal fluid of Lactobacillus-dominant women, but no differences were seen in non-Lactobacillus dominant women. This study provides data suggesting an interaction between the microbiome, hormonal contraceptives, and HIV susceptibility.

show abstract

Section: Introductionmentioning

confidence: 99%

Vaginal microbiome-hormonal contraceptive interactions associate with the mucosal proteome and HIV acquisition

et al. 2020

View full text Add to dashboard Cite

show abstract

“…All authors screened abstracts and full-text articles using Covidence,6 and conflicts were resolved through discussion. Two authors (KC and AT) also screened all the articles included in a companion review of hormonal contraceptive use and risk of HIV acquisition7 to identify any additional studies that included an IUD-only arm.…”

Section: Methodsmentioning

confidence: 99%

Copper intrauterine device use and HIV acquisition in women: a systematic review

Hannaford

Chipato

et al. 2020

BMJ Sex Reprod Health

Self Cite

View full text Add to dashboard Cite

ObjectivesTo review systematically copper intrauterine device (Cu-IUD) use and HIV acquisition in women.MethodsWe searched Pubmed, Embase and the Cochrane Library between database inception and 26 June 2019 for longitudinal studies comparing incident HIV infection among women using an unspecified IUD or Cu-IUD compared with non-hormonal or no contraceptive users, or hormonal contraceptive users. We extracted information from included studies, assessed study quality, and summarised study findings.ResultsFrom 2494 publications identified, seven met our inclusion criteria. One randomised controlled trial (RCT), judged “informative with few limitations”, found no statistically significant differences in HIV risk between users of the Cu-IUD and either intramuscular depot medroxyprogesterone acetate (DMPA-IM) or levonorgestrel implant. One observational study, deemed “informative but with important limitations”, found no statistically significant difference in HIV incidence among IUD users compared with women who had tubal ligation or who were not using any contraception. Another “informative but with important limitations” observational study found no difference in HIV incidence between Cu-IUD users and DMPA or norethisterone enanthate injectable, or implant users. An RCT considered “unlikely to inform the primary question” also found no difference in HIV risk between Cu-IUD and progestogen-only injectable users. Findings from the other three “unlikely to inform the primary question” cohort studies were consistent with the more robust studies suggesting no increased risk of HIV acquisition among Cu-IUD users.ConclusionThe collective evidence, including that from a large high-quality RCT, does not indicate an increased risk of HIV acquisition among users of Cu-IUDs.

show abstract

“…Prof Hallett reports grants USAID and the Bill and Melinda Gates Foundation during the conduct of the study; grants from BMGF, World Bank, UNAIDS, Rush Foundation and Wellcome Trust; and personal fees from BMGF, New York University, WHO and GFATM outside the submitted work. Office of AIDS and TB Research, South African Medical Research Council, Pretoria, South Africa; 3 USAID, Pretoria, South Africa; 4 National Department of Health, Pretoria, South Africa; 5 Botswana Harvard AIDS Institute, Gaborone, Botswana; 6 Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Parktown, South Africa; 9 UNAIDS Eastern and Southern Africa, Johannesburg, South Africa…”

Section: O M P E T I N G I N T E R E S T Smentioning

confidence: 99%

Responding to the ECHO trial results: modelling the potential impact of changing contraceptive method mix on HIV and reproductive health in South Africa

Smith

Beacroft

Abdullah

et al. 2020

J. Intern. AIDS Soc.

View full text Add to dashboard Cite

Introduction: Some observational data suggest that the progestogen injectable contraceptive depot medroxyprogesterone acetate (DMPA) may increase a woman's risk of HIV acquisition but a randomized clinical trial did not find a statistically significant increase in HIV risk for women using DMPA compared to two other methods. However, it could not rule out up to 30% increased HIV risk for DMPA users. We evaluate changes to contraceptive method mix in South Africa under different assumptions about the existence and strength of a possible undetected relationship between DMPA use and HIV risk. Methods: A mathematical model was developed to simulate the ongoing HIV epidemic and contraceptive method mix in South Africa to estimate how changes in method mix could impact HIV-and reproductive health-related outcomes. We made different assumptions about the relationship between DMPA use and HIV risk, from no relationship to a 30% increase in HIV risk for women using DMPA. Scenario analyses were used to investigate the impact of switching away from DMPA predominance to new patterns of contraceptive use. Results: In South Africa, the HIV-related benefits of reduced DMPA use could be as great as the harms of increased adverse reproductive health outcomes over 20 years, if DMPA did increase the risk of HIV acquisition by a relative hazard of infection of 1.1 or greater. A reduction in DMPA use among HIV-positive women would have no benefit in terms of HIV infections, but would incur additional negative reproductive health outcomes. The most important driver of adverse reproductive health outcomes is the proportion of women who switch away from DMPA to no contraceptive method. Conclusions: If there is any real increased HIV risk for DMPA users that has not been detected by the recent randomized trial, a reduction in DMPA use could reduce the ongoing number of new HIV infections. However, such a change would place more women at risk of adverse reproductive health effects. It is imperative that these effects are minimized by focusing on expanding access to safe, effective and acceptable alternative contraceptive methods for all women.

show abstract

Hormonal contraception and HIV acquisition among women: an updated systematic review

Cited by 29 publications

References 31 publications

Vaginal microbiome-hormonal contraceptive interactions associate with the mucosal proteome and HIV acquisition

Vaginal microbiome-hormonal contraceptive interactions associate with the mucosal proteome and HIV acquisition

Copper intrauterine device use and HIV acquisition in women: a systematic review

Responding to the ECHO trial results: modelling the potential impact of changing contraceptive method mix on HIV and reproductive health in South Africa

Contact Info

Product

Resources

About