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WEAC0203 - Oral Abstract Session
Hormonal contraception and HIV acquisition in women: a systematic review of the epidemiological evidence
Presented by Chelsea Polis (United States).
C. Polis1, K. Curtis2
1USAID, Office of Population and Reproductive Health, Washington, United States, 2Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, United States
Background: There are data suggesting that
use of hormonal contraception (HC) might affect the risk of HIV acquisition in
HIV-negative women.
Methods: We conducted a systematic
review of the epidemiological literature on the association between HC and HIV
acquisition. We systematically searched
for relevant articles in any language published or in press by December 15,
2011, evaluated study quality, assessed the association of study findings with
various methodological features, and synthesized the evidence.
Results: We identified twenty relevant
studies, eight of which met minimum quality criteria. Of these, only one reported a statistically
significant association between use of oral contraceptive pills (OCPs) and HIV
acquisition. No studies reported
statistically significant associations between use of norethisterone enantate (Net-En)
and HIV acquisition, but data were limited. Estimates for depot
medroxyprogesterone acetate (DMPA) or non-specified contraceptive injectables
and HIV acquisition were heterogeneous, and we consider factors including analysis
of condom-use information, length of inter-survey interval, and analysis of
serodiscordant couples as possible reasons for heterogeneity.
Conclusions: Overall, current evidence does
not suggest an association between OCP use and HIV acquisition. No currently
available evidence suggests an association between Net-En and HIV acquisition,
though data are limited. Evidence assessing DMPA or non-specified injectable
contraception and risk of HIV acquisition is inconsistent; it does not
establish a clear causal association with HIV acquisition, nor does it
definitively rule out the possibility of an effect. Concerns remain about the potential for residual
confounding, even within otherwise high-quality studies. Many women at risk of
HIV have a critical need for safe and effective means of pregnancy and
infection prevention, and it is imperative that clients and providers are
informed that HC does not protect against HIV or other STIs.
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