More data presented on the thorny issue of hormonal contraception and HIV transmission

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Drs. Sandra McCoy and Renee Heffron (right) present data on hormonal contraceptives and HIV risk at a press conference Tuesday.

Investigators presented more data dissecting the link between hormonal contraceptives and HIV transmission and disease progression Tuesday at the 19th Conference on Retroviruses and Opportunistic Infections in Seattle.

Oral and Injectable Contraception use and risk of HIV acquisition among women, MIRA study

Dr. Sandra McCoy reported on a secondary data analysis of hormonal contraception and HIV acquisition in a sample of 4,913 sexually active women aged 18 to 49 who participated in the Methods for improving Reproductive Health in Africa (MIRA) study.  The average age of the women was 29 years and 61 percent of them were using some kind of hormonal contraception.

There were 274 HIV seroconversions in the group. Hormonal injectables were associated with a modest increased risk of HIV acquisition.  Women who used hormonal injectable contraceptives were 1.4 times more likely to acquire HIV infection when condoms were used infrequently or not at all, compared to women who were not using hormonal contraception.  There was no increased risk seen for HIV acquisition in women using combined oral contraceptives or progesterone-only pills.

According to the study authors, the results underscore the importance of dual protection for women using hormonal injectables and the need for a diverse array of contraceptive options for women.

Hormonal Contraceptive Use and Risk of HIV-1 Disease Progression

Dr. Renee Heffron presented further data analyses from the Partners in Prevention Study regarding the risk of HIV disease progression in HIV infected women using hormonal contraceptives.  In July Heffron presented data at the International AIDS Conference in Rome that demonstrated an increased risk of HIV acquisition in women using hormonal contraceptives.  This study compared HIV disease progression among HIV infected women using and not using hormonal contraception.  HIV disease progression was defined as the need for antiretroviral therapy (ART) initiation, a CD4 count decline to below 200, or death.  The use of intrauterine devices and hormonal implants were excluded due to insufficient numbers.

The study included 2,269 HIV-infected women and included women who had seroconverted during the study.  At enrollment, most women were not using hormonal contraceptives but 31 percent of the women reported using an injectable contraceptive at least once during the study.  The study evaluated contraceptive use over time.

Women using any hormonal injectable contraceptives were less likely to experience HIV disease progression than those that did not.   There were too few women using oral hormonal contraceptives to draw conclusions.  The study authors conclude that it is reassuring that injectable contraceptives do not have a negative effect on disease progression.

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