Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study
Renee Heffron, Deborah Donnell, Helen Rees, Connie Celum, Nelly Mugo, Edwin Were, Guy de Bruyn, Edith Nakku-Joloba, Kenneth Ngure, James Kiarie, Robert W Coombs, Jared M Baeten, Partners in Prevention HSV/HIV Transmission Study Team, C Celum, A Wald, J Lingappa, J M Baeten, M Campbell, L Corey, R W Coombs, J P Hughes, A Magaret, M J McElrath, R Morrow, J I Mullins, D Coetzee, K Fife, E Were, M Essex, J Makhema, E Katabira, A Ronald, S Allen, K Kayitenkore, E Karita, E Bukusi, C Cohen, S Allen, W Kanweka, S Allen, B Vwalika, S Kapiga, R Manongi, C Farquhar, G John-Stewart, J Kiarie, S Allen, M Inambao, S Delany-Moretlwe, H Rees, G de Bruyn, G Gray, J McIntyre, N R Mugo, Renee Heffron, Deborah Donnell, Helen Rees, Connie Celum, Nelly Mugo, Edwin Were, Guy de Bruyn, Edith Nakku-Joloba, Kenneth Ngure, James Kiarie, Robert W Coombs, Jared M Baeten, Partners in Prevention HSV/HIV Transmission Study Team, C Celum, A Wald, J Lingappa, J M Baeten, M Campbell, L Corey, R W Coombs, J P Hughes, A Magaret, M J McElrath, R Morrow, J I Mullins, D Coetzee, K Fife, E Were, M Essex, J Makhema, E Katabira, A Ronald, S Allen, K Kayitenkore, E Karita, E Bukusi, C Cohen, S Allen, W Kanweka, S Allen, B Vwalika, S Kapiga, R Manongi, C Farquhar, G John-Stewart, J Kiarie, S Allen, M Inambao, S Delany-Moretlwe, H Rees, G de Bruyn, G Gray, J McIntyre, N R Mugo
Abstract
Background: Hormonal contraceptives are used widely but their effects on HIV-1 risk are unclear. We aimed to assess the association between hormonal contraceptive use and risk of HIV-1 acquisition by women and HIV-1 transmission from HIV-1-infected women to their male partners.
Methods: In this prospective study, we followed up 3790 heterosexual HIV-1-serodiscordant couples participating in two longitudinal studies of HIV-1 incidence in seven African countries. Among injectable and oral hormonal contraceptive users and non-users, we compared rates of HIV-1 acquisition by women and HIV-1 transmission from women to men. The primary outcome measure was HIV-1 seroconversion. We used Cox proportional hazards regression and marginal structural modelling to assess the effect of contraceptive use on HIV-1 risk.
Findings: Among 1314 couples in which the HIV-1-seronegative partner was female (median follow-up 18·0 [IQR 12·6-24·2] months), rates of HIV-1 acquisition were 6·61 per 100 person-years in women who used hormonal contraception and 3·78 per 100 person-years in those who did not (adjusted hazard ratio 1·98, 95% CI 1·06-3·68, p=0·03). Among 2476 couples in which the HIV-1-seronegative partner was male (median follow-up 18·7 [IQR 12·8-24·2] months), rates of HIV-1 transmission from women to men were 2·61 per 100 person-years in couples in which women used hormonal contraception and 1·51 per 100 person-years in couples in which women did not use hormonal contraception (adjusted hazard ratio 1·97, 95% CI 1·12-3·45, p=0·02). Marginal structural model analyses generated much the same results to the Cox proportional hazards regression.
Interpretation: Women should be counselled about potentially increased risk of HIV-1 acquisition and transmission with hormonal contraception, especially injectable methods, and about the importance of dual protection with condoms to decrease HIV-1 risk. Non-hormonal or low-dose hormonal contraceptive methods should be considered for women with or at-risk for HIV-1.
Funding: US National Institutes of Health and the Bill & Melinda Gates Foundation.
Conflict of interest statement
Conflict of interest disclosures: CC reported receiving research grant support from Glaxo Smith Kline, which did not include salary support and has served on an advisory board for this company. RWC reported receiving research grant support from the National Institutes of Health (NIH) AI-27757 and AI-38858 and Roche Molecular and has served as a consultant for Abbott Molecular. JMB, RH and DD reported receiving research support from the NIH. JMB, CC, GdB, RH, JK, NM, EW, and DD reported receiving grant support from the Bill and Melinda Gates Foundation.
Copyright © 2012 Elsevier Ltd. All rights reserved.
Source: PubMed