Preexposure prophylaxis is efficacious for HIV-1 prevention among women using depot medroxyprogesterone acetate for contraception
Heffron, R.; Mugo, N.; Were, E.; Kiarie, J.; Bukusi, E.A.; Mujugira, A.; Frenkel, L.M.; Donnell, D.; Ronald, A.; Celum, C.; Baeten, J.M.; Celum, C.; Baeten, J.M.; Donnell, D.; Coombs, R.W.; Frenkel, L.M.; Hendrix, C.W.; Lingappa, J.; McElrath, M..Juliana.; Fife, K.; Were, E.; Tumwesigye, E.; Katabira, E.; Katabira, E.; Bukusi, E.; Cohen, C.; Wangisi, J.; Campbell, J.; Tappero, J.; Kiarie, J.; Farquhar, C.; John-Stewart, G.; Mugo, N.Rwamba.; Campbell, J.; Tappero, J.; Wangisi, J.
Aids 28(18): 2771-2776
2014
ISSN/ISBN: 0269-9370 PMID: 25493602 DOI: 10.1097/qad.0000000000000493Document Number: 624412
To evaluate preexposure prophylaxis (PrEP) efficacy for HIV-1 prevention among women using depot medroxyprogesterone acetate (DMPA) for contraception and men whose HIV-1-infected partners use DMPA. Secondary analysis of data from a randomized placebo-controlled trial of daily oral tenofovir and emtricitabine/tenofovir PrEP among heterosexual Kenyan and Ugandan HIV-1 serodiscordant couples. PrEP efficacy for HIV-1 prevention was compared among HIV-1-uninfected women using DMPA versus no hormonal contraception and among HIV-1 uninfected men whose HIV-1-infected female partners used DMPA versus no hormonal contraception. Of 4747 HIV-1 serodiscordant couples, 901 HIV-1-uninfected women used DMPA at some point during follow-up, 1422 HIV-1-uninfected women used no hormonal contraception, 1568 HIV-1-uninfected men had female partners who used DMPA, and 2626 men had female partners who used no hormonal contraception. PrEP efficacy estimates for HIV-1 prevention, compared with placebo, were similar among women using DMPA and those using no hormonal contraception (64.7 and 75.5%, adjusted interaction P = 0.65). Similarly, for men whose female partners used DMPA, PrEP efficacy did not differ from men whose partners used no hormonal contraception (90.0 versus 81.7%, adjusted interaction P = 0.52). PrEP is efficacious for HIV-1 prevention among women using DMPA and men whose partners use DMPA, suggesting PrEP could mitigate the potential increased HIV-1 acquisition and transmission risks that have been associated with DMPA use. Women at risk for HIV-1 choosing DMPA could maintain this contraceptive method and add PrEP to achieve prevention of unintended pregnancy and HIV-1.