News Release

Study finds use of hormonal contraception doubles a woman's chance of becoming infected with HIV and of transmitting the virus to their male partner

Peer-Reviewed Publication

The Lancet_DELETED

Using hormonal contraception doubles a women's risk of acquiring HIV-1 and of transmitting the virus to their male partner, according to a study of nearly 3800 couples published Online First in The Lancet Infectious Diseases. The risk was significantly higher for women using injectable methods of contraception.

"These findings have important implications for family planning and HIV-1 prevention programmes, especially in settings with high HIV-1 prevalence", explains Jared Baeten from the University of Washington, Seattle, USA, one of the study's authors.

"Recommendations regarding contraceptive use, particularly emphasising the importance of dual protection with condoms and the use of non-hormonal and low-dose hormonal methods for women with or at risk for HIV-1, are urgently needed", adds lead study author Renee Heffron, also from the University of Washington.

More than 140 million women worldwide use hormonal contraception, including daily oral pills and long-acting injectables. A high proportion of the 16 million women living with HIV in sub-Saharan Africa also use hormonal contraception. Previous studies have investigated whether hormonal contraceptives might alter a women's risk of becoming infected with HIV, but results have been inconsistent.

This study was designed to establish whether hormonal contraception increases the risk of women acquiring HIV and transmitting the virus to their male partners. The study included 3790 heterosexual HIV-1 serodiscordant couples (ie, one partner with HIV-1 infection the other without) who were participating in two longitudinal studies of HIV-1 incidence in seven African countries (Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda, and Zimbabwe).

Findings showed that using hormonal contraceptives doubled a woman's chances of becoming infected with HIV-1. The risk was increased for both injectable (mainly depot medroxprogeterone acetate: DMPA) and oral contraceptives, although it was not statistically significant for oral contraceptives.

Additionally, women who were HIV-positive at the beginning of the study and using injectable contraception were twice as likely to transmit the virus to their male partner compared to women who did not use hormonal contraception.

"To our knowledge, ours is the first prospective study to show increased HIV-1 risk in male partners of HIV-1 infected women using hormonal contraception", say the authors.

They conclude: "Data on HIV-1 risk associated with…other hormonal contraceptives, such as implants, patches, or combined injectables…and non-hormonal contraceptive methods such as intrauterine devices, are urgently needed, and strategies to improve accessibility and uptake of these lower-dose and non-hormonal methods should be prioritised. Contraceptive counselling should be combined with HIV-1 counselling and testing."

In a Comment, Charles S Morrison from Clinical Sciences, Durham, USA, says: "Active promotion of DMPA in areas with high HIV incidence could be contributing to the HIV epidemic in sub-Saharan Africa, which would be tragic. Conversely, limiting one of the most highly used effective methods of contraception in sub-Saharan Africa would probably contribute to increased maternal mortality and morbidity and more low birthweight babies and orphans—an equally tragic result. The time to provide a more definitive answer to this critical public health question is now; the donor community should support a randomised trial of hormonal contraception and HIV acquisition."

###

Dr Jared Baeten, University of Washington, Seattle, USA. T) +1 206 601 8598 E) jbaeten@uw.edu

Dr Charles S Morrison, Clinical Sciences, Durham, USA. Via Hannah Burris, T) +1 703 647 1951 E) hburris@fhi360.com


Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.