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Does injectable hormonal contraception increase the risk of HIV infection?
Gus Cairns, 2012-07-27 01:20:00
The 19th International AIDS Conference (AIDS 2012) heard further contradictory evidence this week on whether hormonal contraceptives, especially injectable ones, raise the risk to women of acquiring HIV and, if they already have HIV, of developing AIDS.
A review of a randomised controlled trial of herpes suppression in serodiscordant couples, as well as a re-analysis of the study in which the link was first seen, found strengthened evidence for increased risk.
Women using injectable contraceptives were 2.6 times more likely to acquire HIV, and women using DMPA (depot medroxyprogesterone acetate, Depo Provera) were 3.4 times more likely to acquire HIV. These results were statistically significant.
Furthermore, an analysis of another randomised controlled study (RCT), which investigated progression to AIDS in women using either a copper intra-uterine device (IUD) or DMPA as contraceptives, found a significant 60% raised risk of progression to AIDS in HIV-positive women using DMPA. However, this study was hampered by the lack of comparator arms in which women used oral contraception or condoms only.
On the other hand, two meta-analyses by the US Centers for Disease Control (CDC) found no link between hormonal contraceptives (in general) and HIV acquisition or progression in 14 observational cohort studies of HIV acquisition and six of progression to AIDS. They did find an increased risk of HIV in women using DMPA in one out of 15 observational studies and possibly one other, depending on how it was analysed.
None of these studies, however, including the RCTs, were specifically designed to look at an association between HIV incidence or progression and contraception method as a primary outcome.
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