Update on Hormonal Contraceptive Methods and Risk of HIV Acquisition in Women: a Systematic Review of Epidemiological Evidence, 2016

October 2016 - Epidemiology

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Polis, C.B., Curtis, K.M., Hannaford, P.C., et al. AIDS (August 2016), doi: 10.1097/QAD.0000000000001228.

Previous research has shown an association between injectable depot medroxyprogesterone acetate (DMPA) and the risk of HIV acquisition. The authors of this review update analyzed 31 studies, 10 of which provided new data, from 2014–2016, about the influence of hormonal contraceptive types on HIV risk. Most of the studies examined oral contraceptive or injectable methods (DMPA and norethisterone oenanthate [NET-EN]). None examined hormonal patches, rings, combined injectables, or levonorgestrel intrauterine devices. Results indicated that levonorgestrel implants do not increase HIV risk; but data were limited, and more research is needed. Of 11 studies on oral contraceptive, only 1 reported slightly elevated HIV risk. Five of twelve studies on injectables showed higher HIV risk. Two additional studies found a 41 percent greater HIV acquisition risk with DMPA compared to NET-EN; NET-EN injectable did not increase HIV acquisition risk. DMPA again was found to have increased HIV acquisition risk when compared to combination oral contraceptives. Women who took DMPA were also more likely to acquire HIV than those using no hormonal methods. The authors concluded that despite questions about confounding factors and study methodology, and variance among study findings, the newer studies reinforce the associations between DMPA and HIV risk that were noted by previous research. They recommended that the World Health Organization consider reevaluating guidance on DMPA.

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