PLoS Medicine (Jan 2015)

Hormonal contraception and the risk of HIV acquisition: an individual participant data meta-analysis.

  • Charles S Morrison,
  • Pai-Lien Chen,
  • Cynthia Kwok,
  • Jared M Baeten,
  • Joelle Brown,
  • Angela M Crook,
  • Lut Van Damme,
  • Sinead Delany-Moretlwe,
  • Suzanna C Francis,
  • Barbara A Friedland,
  • Richard J Hayes,
  • Renee Heffron,
  • Saidi Kapiga,
  • Quarraisha Abdool Karim,
  • Stephanie Karpoff,
  • Rupert Kaul,
  • R Scott McClelland,
  • Sheena McCormack,
  • Nuala McGrath,
  • Landon Myer,
  • Helen Rees,
  • Ariane van der Straten,
  • Deborah Watson-Jones,
  • Janneke H H M van de Wijgert,
  • Randy Stalter,
  • Nicola Low

DOI
https://doi.org/10.1371/journal.pmed.1001778
Journal volume & issue
Vol. 12, no. 1
p. e1001778

Abstract

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BackgroundObservational studies of a putative association between hormonal contraception (HC) and HIV acquisition have produced conflicting results. We conducted an individual participant data (IPD) meta-analysis of studies from sub-Saharan Africa to compare the incidence of HIV infection in women using combined oral contraceptives (COCs) or the injectable progestins depot-medroxyprogesterone acetate (DMPA) or norethisterone enanthate (NET-EN) with women not using HC.Methods and findingsEligible studies measured HC exposure and incident HIV infection prospectively using standardized measures, enrolled women aged 15-49 y, recorded ≥15 incident HIV infections, and measured prespecified covariates. Our primary analysis estimated the adjusted hazard ratio (aHR) using two-stage random effects meta-analysis, controlling for region, marital status, age, number of sex partners, and condom use. We included 18 studies, including 37,124 women (43,613 woman-years) and 1,830 incident HIV infections. Relative to no HC use, the aHR for HIV acquisition was 1.50 (95% CI 1.24-1.83) for DMPA use, 1.24 (95% CI 0.84-1.82) for NET-EN use, and 1.03 (95% CI 0.88-1.20) for COC use. Between-study heterogeneity was mild (I(2) ConclusionsThis IPD meta-analysis found no evidence that COC or NET-EN use increases women's risk of HIV but adds to the evidence that DMPA may increase HIV risk, underscoring the need for additional safe and effective contraceptive options for women at high HIV risk. A randomized controlled trial would provide more definitive evidence about the effects of hormonal contraception, particularly DMPA, on HIV risk.