Hormonal contraceptives associated with no added risk of HIV transmission

Does hormonal contraception raise the risk of HIV transmission?  Contraceptive choice may have an impact on sexual risk-taking behaviour, of course; but there has also been a concern that vaginal epithelium thinning arising from a progesterone-induced anovulatory state may reduce the efficacity of the vaginal barrier (Mitchell & Stephens, 2004).

Now a retrospective analysis of statistical data from an HIV-microbicide trial completed three years ago (HPTN 035) claims to offer reassuring evidence that injected forms of hormonal contraception are not associated with higher rates of HIV transmission.  Researchers from the Microbicides Trials Network (MTN) were reporting to the International Microbicides Conference (M2012), which met in Sydney 15th – 18th April.

These findings could hardly be more topical.  Last October a study published in the Lancet (Heffron, 2011) and subsequently reported in the New York Times, sent a wave of anxiety through the global health protection community with the claim that HIV-negative women might face a two-fold increased risk of acquiring the infection from their HIV-positive partners, and that HIV-positive women could have a two-fold increased risk of passing it on to the non-infected partners. The issue has enormous implications given the wide-scale use of injected hormonal contraception in areas of high HIV prevalence.  Around 12 million of all women in sub-Saharan Africa between the ages of 16 and 49, 6% of all women in this age-group, use this method.  Research, published in this journal and elsewhere, has emphasized, among its many advantages, the potential value of contraception as a prevention tool to combat vertical HIV transmission (mother to child) (Wilcher, Petruney, Reynolds & Cates, 2008; Reynolds, Janowitz, Wilcher, Cates, 2008; Reynolds, Steiner  & Cates, 2005).  Should the results of the Heffron study be even partially confirmed through further research, it is unclear how public health authorities would go about squaring the benefits of injectable hormonal contraception with increased HIV transmission risk.  In the meantime the World Health Organization and UNAID have not recommended any change in public health practice.

In such a context this report can hardly fail to make an impact, and the global public health community will no doubt be awaiting with interest the publication of the study.

H.S. Mitchell & E. Stephens, “Contraception Choice for HIV positive women”, Sexually Transmitted Infections 2004:80;3

[Abstract]  [Full text]  [PDF]

R. Wilcher, T. Petruney, H.W. Reynolds, W. Cates, “From effectiveness to impact: contraception as an HIV prevention intervention”, Sexually Transmitted Infections 2008:84;Suppl. 2

[Abstract][Full text][PDF]

H.W. Reynolds, B. Janowitz, R. Wilcher, W. Cates, “Contraception to prevent HIV-positive births: current contribution and potential cost savings in PEPFAR countries”, Sexually Transmitted Infections 2008:84 suppl.2

[Abstract][Full text][PDF]

H.W. Reynolds, M.J. Steiner, W. Cates, “Contraception’s proved potential to fight HIV” (Letter), Sexually Transmitted Infections:81;2

[Extract][Full text][PDF]

Renee Heffron, Jared Baeten et al., “Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study”, The Lancet Infectious Diseases, Vol. 12, Issue 1

http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(11)70247-X/abstract

For M2012 report see:

http://www.news-medical.net/news/20120418/No-added-HIV-risk-with-hormonal-contraceptives.aspx

 

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