Hormonal contraception and the risk of HIV acquisition among women in South Africa

Morrison, Charles; Skoler-Karpoff, Stephanie; Kwok, Cynthia; Chen, Pai-Lien; Wijgert, Janneke van de; Gehret-Plagianos, Marlena; Patel, Smruti; Ahmed, Khatija; Ramjee, Gita; Friedland, Barbara; Lähteenmäki, P

doi:10.1097/qad.0b013e32834fa13d

Cited by 75 publications

(83 citation statements)

References 17 publications

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“…Some recent publications suggest that DMPA use is associated with a significantly higher risk of acquiring HIV (2)(3)(4), although other studies did not find this association (5,6). Use of DMPA has previously also been linked to increased risk of acquisition of other sexually transmitted diseases, such as Trichomonas vaginalis, Neisseria gonorrhoeae, and Chlamydia trachomatis (7).…”

mentioning

confidence: 87%

The Contraceptive Depot Medroxyprogesterone Acetate Impairs Mycobacterial Control and Inhibits Cytokine Secretion in Mice Infected with Mycobacterium tuberculosis

et al. 2013

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dThe contraceptive depot medroxyprogesterone acetate (DMPA), with progestin as the single active compound, possesses selective glucocorticoid activity and can alter the expression of glucocorticoid receptor-regulated genes. We therefore propose that pharmacological doses of DMPA used for endocrine therapy could have significant immune modulatory effects and impact on susceptibility to, as well as clinical manifestation and outcome of, infectious diseases. We investigated the effect of contraceptive doses of DMPA in two different murine Mycobacterium tuberculosis models. Multiplex bead array analysis revealed that DMPA altered serum cytokine levels of tumor necrosis factor alpha (TNF-␣), granulocyte colony-stimulating factor (G-CSF), and interleukin 10 (IL-10) in C57BL/6 mice and gamma interferon (IFN-␥) in BALB/c mice. DMPA also suppressed antigen-specific production of TNF-␣, G-CSF, IL-10, and IL-6 and induced the production of IP-10 in C57BL/6 mice. In BALB/c mice, DMPA altered the antigen-specific secretion of IFN-␥, IL-17, granulocyte-macrophage colony-stimulating factor (GM-CSF), IL-6, and monocyte chemotactic protein 1 (MCP-1). Furthermore, we show that C57BL/6 mice treated with doses of DMPA, which result in serum concentrations similar to those observed in contraceptive users, have a significantly higher bacterial load in their lungs. Our data show for the first time that DMPA impacts tuberculosis (TB) disease severity in a mouse model and that the effects of this contraceptive are not confined to infections of the genital tract. This could have major implications for the contraceptive policies not only in developing countries like South Africa but also worldwide.

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confidence: 87%

The Contraceptive Depot Medroxyprogesterone Acetate Impairs Mycobacterial Control and Inhibits Cytokine Secretion in Mice Infected with Mycobacterium tuberculosis

et al. 2013

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“…Resultados El riesgo de seroconversión del VIH-1 fue superior en las mujeres que declararon utilizar anticonceptivos hormonales en el momento de la inscripción en el ensayo (índice de riesgos ajustado: 1,24; IC del 95%: 0,97-1,58) que en las mujeres que declararon utilizar otros tipos de anticonceptivos. Entre la población, el uso de anticonceptivos hormonales (píldoras o inyectables) en el punto de partida y durante el seguimiento del estudio representó aproximadamente el 20% (IC del 95%: [16][17][18][19][20][21][22] de las seroconversiones del VIH-1. No obstante, el riesgo parcial atribuible a la población indicó un impacto relativo del 12% (IC del 95%: 9.0-15.7).…”

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“…19 Morrison et al combined the multisite data from the Carraguard® trial, including the Durban site data, and showed a moderately increased risk of HIV-1 seroconversion with the use of the injectable progestin depo-medroxyprogesterone acetate, but no effect with other types of hormonal contraceptives. 20 Based on available data, in 2012 the World Health Organization released a technical statement clarifying that the data on hormonal contraceptives was inconclusive and that women should continue to use hormonal contraceptives to prevent unwanted pregnancy. Nonetheless, it advised women using progesterone-only contraception to use condoms and other methods for preventing HIV-1 infection.…”

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confidence: 99%

Population-level impact of hormonal contraception on incidence of HIV infection and pregnancy in women in Durban, South Africa

Ramjee¹,

Wand²

2012

Bull World Health Org

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“…In a systematic review [67], four of nine studies considered informative but with important limitations reported a 1.5 to 2.2 times increased risk of HIV acquisition in women using injectable contraception(DMPA) [3,28,56,87]. The remaining five studies of injectable contraception in the review [39,57,62,71] reported no statistically significant association with risk of HIV acquisition. In the same review [67], only one study reported increased risk of acquisition resulting from the use of oral contraceptive pills (OCPs).…”

Section: Introductionmentioning

confidence: 99%

Assessing the Potential Impact of Hormonal-Based Contraceptives on HIV Transmission Dynamics Among Heterosexuals

2017

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Background: HIV susceptibility linked to hormonal contraception (HC) has been studied before, but with mixed results. Recent findings have prompted the World Health Organisation (WHO), to encourage women who use HC to concurrently use condoms in order to prevent HIV infection in light of possible increased HIV risk of infection associated with hormone based contraceptives. Methods and Findings: A two sex HIV model classifying women into three risk groups consisting of individuals who use condoms, natural methods and hormone based contraceptives is formulated and analysed to assess the effects of various birth control methods on the transmission dynamics of the disease. Our model results showed that women who use HC could be key drivers of the epidemic and that their increased infectivity may be critical in driving the epidemic. Women who use hormone based contraceptives potentially act as a core-group from which men get infected and in turn transmit the disease to other population groups. We fitted the model to HIV prevalence data for Zimbabwe reported by UNAIDS and Zimbabwe Ministry of Health and Child welfare (MoHCW) and used the model fit to project HIV prevalence. Predictions using HIV data for Zimbabwe suggest that a hypothesised increase in susceptibility and infectivity of 2, 3, and 4 fold would result in a 25%, 50% and 100% increase in baseline HIV prevalence projection respectively, thus suggesting possible increased disease burden even in countries reporting plausible HIV prevalence declines. Conclusion:Although a possible causal relationship between HIV susceptibility and HC use remains subject of continuing scientific probe, its inclusion as part of birth control strategy, has been shown in this study, to possibly have significant influence on HIV transmission. If proven, HC use may potentially explain the inordinate spread of HIV within the sub-Saharan Africa region and therefore compel for urgent assessment with a view to reorienting birth control methods in use in settings with generalised epidemics.

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Hormonal contraception and the risk of HIV acquisition among women in South Africa

Abstract: In this study conducted among South African women, hormonal contraception did not significantly increase the risk of HIV acquisition. However, the effect estimate does not rule out a moderate increase in HIV risk associated with DMPA use found in some other recent studies.

Cited by 75 publications

References 17 publications

The Contraceptive Depot Medroxyprogesterone Acetate Impairs Mycobacterial Control and Inhibits Cytokine Secretion in Mice Infected with Mycobacterium tuberculosis

The Contraceptive Depot Medroxyprogesterone Acetate Impairs Mycobacterial Control and Inhibits Cytokine Secretion in Mice Infected with Mycobacterium tuberculosis

Population-level impact of hormonal contraception on incidence of HIV infection and pregnancy in women in Durban, South Africa

Assessing the Potential Impact of Hormonal-Based Contraceptives on HIV Transmission Dynamics Among Heterosexuals

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