To investigate whether the incidence of HIV infection is higher among sexually active women using depot medroxyprogesterone acetate (DMPA) or noresthisterone enanthate (NET-EN) injections for contraception than among women using nonhormonal or no contraception.
Methods
Five hundred and fifty-one initially HIV-negative women were followed up for a total of 491 person-years. Participants were interviewed, counselled, examined, tested for HIV and other STIs, and treated, at three monthly intervals for 1 year.
Results
There was no significant association between progestin contraceptive use and HIV infection (rate ratio 1.1, 95% CI 0.5 to 2.8; log-rank test, p=.73). In proportional hazards regression, the only significant hazard ratios for HIV acquisition were prevalent Neisseria gonorrhoea (5.2; 95% CI 1.1 to 23.7, p=.035) and Trichomonas vaginalis (4.8; 95% CI 1.0 to 22.8, p=.049); bacterial vaginosis was marginally significant (2.8; 95% CI 1.0 to 8.3, p=.057). The adjusted hazard ratios for NET-EN and DMPA were 1.76 (95% CI 0.64 to 4.84) and 0.46 (95% CI 0.06 to 3.79), respectively, relative to nonuse. Five hundred and twelve of 551 women had one or more confirmed STIs during the study.
Conclusions
There is no evidence of an association between HIV infection and injectable contraceptives. Due to the limited power of this study and because similar studies have not included young women using NET-EN, we recommend that further research be carried out to focus on the use of NET-EN and HIV acquisition in high risk groups.
DMPA injectable contraceptive HIV risk South Africa, depot medroxyprogesterone acetate HIV acquisition women, norethisterone enanthate NET-EN HIV infection risk, hormonal contraception HIV transmission prospective cohort, progestin contraceptive sexually transmitted infection STI risk, injectable contraceptives immune function HIV vulnerability, bacterial vaginosis gonorrhea trichomonas HIV cofactors, family planning contraceptive safety HIV endemic settings, Kleinschmidt Rees injectable progestin HIV South Africa, hormonal contraception STI coinfection proportional hazards analysis
PMID 17519153 17519153 DOI 10.1016/j.contraception.2007.02.002 10.1016/j.contraception.2007.02.002
Cite this article
Kleinschmidt, I., Rees, H., Delany, S., Smith, D., Dinat, N., Nkala, B., & McIntyre, J. A. (2007). Injectable progestin contraceptive use and risk of HIV infection in a South African family planning cohort. *Contraception*, *75*(6), 461-467. https://doi.org/10.1016/j.contraception.2007.02.002
Kleinschmidt I, Rees H, Delany S, Smith D, Dinat N, Nkala B, et al. Injectable progestin contraceptive use and risk of HIV infection in a South African family planning cohort. Contraception. 2007;75(6):461-467. doi:10.1016/j.contraception.2007.02.002
Kleinschmidt, I., et al. "Injectable progestin contraceptive use and risk of HIV infection in a South African family planning cohort." *Contraception*, vol. 75, no. 6, 2007, pp. 461-467.
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