October 4th, 2011

Hormonal Contraception MAY Increase Risk of HIV

From the pages of Lancet Infectious Diseases, a study from Africa:

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 … Among 1314 couples in which the HIV-1-seronegative partner was female, 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, 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).

We’ve heard this story before, that hormonal contraception may increase the risk of HIV acquisition. The mechanism is unclear — vaginal thinning, increased HIV replication in genital secretions, something else — but undoubtedly part of it may be the simple fact that women receiving hormonal contraception must be less likely to use condoms.

In fact, that last factor is pretty darn likely, and why the results cannot be considered definitive — even though condom use was controlled for in the study.

Lack of concrete proof notwithstanding, women should be counseled that hormonal contraception could increase the risk of HIV acquisition and transmission — and hence it’s even more important that condom use be emphasized, especially in high HIV prevalence regions.

6 Responses to “Hormonal Contraception MAY Increase Risk of HIV”

  1. dr k.a. okemwa says:

    i dont know the impact it will have on contraceptive use as the message the public is most likely to pick is that these contaceptives actually predispose one to HIV therefore many will shy off from using the contraceptives -with an adverse effect on family planning.

  2. Ed Emig says:

    Another of the many reasons for a much broader promotion of natural family planning methods.

  3. In Spain, prostitutes use to say, and I’m not an user of their services, that not even God is going to make many spanish men use a condom. Do the higher HIV risk connected to OC use has a correlations with the promiscuity of women users ? This is an old question, apparently usually answered as no, but it would be interesting repeating it on every occassion.

  4. Dr Ssebulia says:

    Alot(Negative effects) have been associated with Hormonal contraception!But this is a bang! The biggest we have ever heard!

  5. AMoura says:

    That´s just another evidence showing that the couple is usually much more afraid of pregnancy than HIV. It is difficult to convince people that double barrier (hormone+condom)is the way to go.

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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