Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study
Heffron, R.; Donnell, D.; Rees, H.; Celum, C.; Mugo, N.; Were, E.; de Bruyn, G.; Nakku-Joloba, E.; Ngure, K.; Kiarie, J.; Coombs, R.W.; Baeten, J.M.; Celum, C.; Wald, A.; Lingappa, J.; Baeten, J.M.; Campbell, M.; Corey, L.; Coombs, R.W.; Hughes, J.P.; Magaret, A.; McElrath, M.J.; Morrow, R.; Mullins, J.I.; Coetzee, D.; Fife, K.; Were, E.; Essex, M.; Makhema, J.; Katabira, E.; Ronald, A.; Allen, S.; Kayitenkore, K.; Karita, E.; Bukusi, E.; Cohen, C.; Allen, S.; Kanweka, W.; Allen, S.; Vwalika, B.
LANCET. Infectious Diseases 12(1): 19-26
2012
ISSN/ISBN: 1474-4457 PMID: 21975269 DOI: 10.1016/s1473-3099(11)70247-xDocument Number: 534852
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. 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. 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. 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. US National Institutes of Health and the Bill & Melinda Gates Foundation.