ATLANTA, GA — The thorny issue of the relationship between hormonal contraceptives and HIV infection was highlighted again at this year’s CROI conference by Angela Crook from the University of the Witwatersrand, South Africa. As usual, limited contraceptive options, high rates of maternal and child mortality in African settings, and the role of pregnancy itself in increasing vulnerability to HIV against a number of studies are part of the backdrop for any discussion that seems to suggest that hormonal contraceptives increase HIV acquisition risk.
This study like several others was a secondary analysis of a microbicide trial—MDP 301– testing a product called Pro2000 which proved ineffective in protecting the trial participants from HIV. This is the largest look at a population of women, with 8663 study participants from four sub-Saharan African countries—South Africa, Uganda, Tanzania and Zambia. There were significantly more HIV infections in the group of women using injectable but the analysis identified age as a key factor. Younger women were more likely to use injectable contraceptives, more likely to have sexually transmitted infections and less likely to report condom use. The other key factor was the location of the trial center, with more infections identified in trial centers located in communities with higher HIV prevalence. Nevertheless, consistent with previous studies, a small increased risk of HIV acquisition among women using the injectable, Depo Provera.