XIX International AIDS Conference


WEAC02 Hormonal Contraception and HIV: an Evolving Controversy
  Oral Abstract Session : Track C
Venue: Session Room 2
Time: 25.07.2012, 14:30 - 16:00
Co-Chairs: Adaora Adimora, United States
Helen Rees, South Africa
 
 

14:30
WEAC0201
Abstract
Association between STI/RTI infections, altered cervical innate immunity and HIV-1 seroconversion among hormonal contraceptive users
R. Fichorova1, C. Morrison2, G. Doncel3, P.-L. Chen2, C. Kwok2, T. Chipato4, R. Salata5, C. Mauck6
1Brigham and Women's Hospital, Harvard Medical School, Boston, United States, 2Family Health International (FHI 360), Durham, United States, 3CONRAD, Eastern Virginia Medical School, Norfolk, United States, 4University of Zimbabwe, Harare, Zimbabwe, 5Case Western Reserve University, Cleveland, United States, 6CONRAD, Eastern Virginia Medical School, Arlington, United States
R. Fichorova, United States

14:45
WEAC0202
Abstract
Powerpoint
Webcast
Association of injectable contraception and risk of HIV-1 acquisition in women in HIV-1 serodiscordant partnerships: persistence of effect in multiple sensitivity analyses
R. Heffron1, D. Donnell2, H. Rees3, C. Celum1, N. Mugo1,4, E. Were5, G. de Bruyn3, E. Nakku-Joloba6, K. Ngure4, J. Kiarie1,4, R. Coombs1, J. Baeten1, Partners in Prevention HSV/HIV Transmission Study Team
1University of Washington, Seattle, United States, 2Fred Hutchinson Cancer Research Center, Seattle, United States, 3University of Witswatersrand, Johannesburg, South Africa, 4Kenyatta National Hospital, Nairobi, Kenya, 5Moi University, Eldoret, Kenya, 6Makerere College of Health Sciences, Kampala, Uganda
R. Heffron, United States

15:00
WEAC0203
Abstract
Powerpoint
Webcast
Hormonal contraception and HIV acquisition in women: a systematic review of the epidemiological evidence
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
C. Polis, United States

15:15
WEAC0204
Abstract
Powerpoint
Webcast
Hormonal contraception and HIV disease progression: a systematic review of the epidemiological evidence
S. Phillips1, K. Curtis2, C. Polis3
1World Health Organization, Reproductive Health and Research, Geneva, Switzerland, 2Centers for Disease Control & Prevention, Division of Reproductive Health, Atlanta, United States, 3US Agency for International Development, Office of Population and Reproductive Health, Washington, United States
S. Phillips, Switzerland

Powerpoints presentations
Association of injectable contraception and risk of HIV-1 acquisition in women in HIV-1 serodiscordant partnerships: persistence of effect in multiple sensitivity analyses - Renee Heffron

Hormonal contraception and HIV acquisition in women: a systematic review of the epidemiological evidence - Chelsea Polis

Hormonal contraception and HIV disease progression: a systematic review of the epidemiological evidence - Sharon Phillips



Rapporteur report

Track C report by Sinead        Delany


This session highlighted the controversy that remains around the role of hormonal contraception in HIV acquisition, transmission and disease progression, and the need for stronger evidence to determine whether harm exists. The importance of expanding the range of contraceptive options for women in high risk settings was emphasised.

 Further analysis of data from an African sero-discordant couple cohort confirmed initial findings by Heffron and colleagues that hormonal contraception increased the risk of HIV acquisition two-fold. Adjustments for coital frequency, and reporting of unprotected sex by the women or her male partner, did not alter these results. Reducing misclassification by controlling for contraceptive switching, and attempting to isolate the effect of DMPA by excluding non-DMPA users also did not alter this outcome substantially.

 A systematic review of 8 studies evaluated the evidence for hormonal contraception as a risk for HIV acquisition. Of the studies reviewed, only one showed evidence of a risk between the use of oral contraceptives and HIV acquisition. Eight studies evaluating the association between injectable contraceptive use and the risk of HIV acquisition had heterogeneous results. No clear causal association could be established with the current data. Sources of confounding include condom use, lack of data on male partner HIV status and level of transmission risk in most studies, and imprecise estimates of timing of infection.

Insights into the biological plausibility of HIV acquisition associated with hormonal contraceptive use were provided in a cross-sectional study of 199 recently infected women and 633 controls matched on age and time in study. When compared to non-hormonal users, injectable contraceptive use with DMPA was associated with lower levels of the anti-inflammatory regulator IL-1RA overall and, in women with selected STI, with significantly lower odds of IL-1RA concentrations. These data suggest that hormonal contraceptives differentially modulate levels of protective immune mediators in the genital tract, altering responses to STIs and providing insights into the mechanism of HIV acquisition.

A systematic review of the effect of hormonal contraception (HC) on HIV disease progression found that despite the existence of at least one randomised controlled trial suggesting that HC enhanced HIV disease progression, the preponderance of evidence across several studies suggest that there is no evidence of excess harm in HIV positive women.

Combined these data raise questions about the potential risks associated with hormonal contraception, but need to be balanced against the risks associated with an unwanted pregnancy in the populations at risk for HIV. These data highlight the need for trials to provide definitive evidence on the causal role of hormonal contraception in HIV acquisition, and emphasise the need for expanding the range of alternative contraceptive options for women living in high HIV prevalence settings.




   

    The organizers reserve the right to amend the programme.


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