Lancet Infect Dis, 12(1), 19-26
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.
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., & Partners in Prevention HSV/HIV Transmission Study Team (2012). Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study. *The Lancet. Infectious diseases*, *12*(1), 19-26. https://doi.org/10.1016/S1473-3099(11)70247-X
Heffron R, Donnell D, Rees H, Celum C, Mugo N, Were E, et al. Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study. Lancet Infect Dis. 2012;12(1):19-26. doi:10.1016/S1473-3099(11)70247-X
Heffron, R., et al. "Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study." *The Lancet. Infectious diseases*, vol. 12, no. 1, 2012, pp. 19-26.