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Hormonal contraceptives doubled risk for HIV infection, transmission
Heffron R. Lancet infect Dis. 2011;doi:10.1016/S1473-3099(11)70247-X.
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Researchers observed a twofold increased risk for HIV-1 acquisition and transmission among women who used hormonal contraception, particularly injectable methods, according to new findings published in The Lancet Infectious Diseases.
Renee Heffron, MPH, of the University of Washington, and colleagues, therefore, said women should be counseled about the importance of dual protection with condoms to decrease risk, and those with or at-risk for HIV-1 should consider use of non-hormonal or low-dose hormonal contraceptive methods.
“Hormonal contraception is extremely important, and women need to understand the importance of using methods to reduce their risk for HIV — like condoms — even when they are using a hormonal method to prevent unintended pregnancy,” Heffron told Infectious Disease News. “For women who choose to use injectable contraceptives, they should be counseled that they are not protected against HIV by their contraceptive injection, and in fact, it is even more important that they use condoms when they use injectable contraceptives to prevent HIV.”
In the prospective cohort study, the researchers examined the association between hormonal contraceptive use and risk for HIV-1 in HIV-1 uninfected women, and the risk of transmission to male partners from HIV-1 infected women. The cohort included 3,790 heterosexual HIV-1-serodiscordant couples across seven African countries.
Of 1,314 couples in which the HIV-1-seronegative partner was female, compared with 3.78 per 100 person-years in those who did not use hormonal contraception, HIV-1 acquisition rates were 6.61 per 100 person-years in those who reported use (adjusted HR=1.98; 95% CI, 1.06–3.68).
Of the couples in which the HIV-1-seronegative partner was male (n=2,476), HIV-1 transmission rates were 2.61 per 100 person-years among couples in which women reported use of hormonal contraception vs. 1.51 per 100 person-years among couples in which women did not use hormonal contraception (adjusted HR=1.97; 95% CI, 1.12–3.45).
“Our data provide compelling evidence that hormonal contraceptives double HIV risk — both the risk for women to acquire HIV and for HIV-infected women to pass the infection to their male partners,” Jared Baeten, MD, PhD, of the University of Washington and a study investigator, told Infectious Disease News. “Safe and effective contraception is a public health imperative, and our results should not diminish use of contraception, including hormonal contraception, which is highly effective for family planning.
“Nonetheless, since hormonal contraceptives do not decrease a woman’s chances of acquiring or transmitting HIV, women should be counseled that dual-protection — contraception for pregnancy and condoms for HIV and other sexually transmitted infections — should be the goal,” Baeten said. – by Ashley DeNyse
Disclosure: This research was funded by the NIH and the Bill & Melinda Gates Foundation.
HIV transmission and sex are intimate partners. This article underscores the need to consider all possible ways in which efforts to change sexual behaviors or HIV risk might have unintended consequences. In this case, contraceptives, which might allow more frequent sexual acts, could increase HIV risk if condoms were not used or were used less often than previous to contraceptive prescription. Preventing one effect of sex - pregnancy - does not necessarily prevent another effect, such as sexually transmitted infections. It has somewhat similarly been observed that non-barrier methods of preventing HIV-infection, such as ART will not decrease other sexually transmitted infections and the recent rise in syphilis in men who have sex with men may be an example. The infectious disease community clearly needs to be fully aware of these relationships in counseling patients on ways to stay free of HIV and other infections while enjoying healthy sexual lives.
– Paul Volberding, MD
Infectious Disease News Chief Medical Editor
Disclosure: Dr. Volberding reports no relevant financial disclosures.
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