Category: HIV Sexual Transmission
Released on Friday, January 16 2015 00: 00
Written by Liz Highleyman
Women using the long-acting injectable Depo-Provera contraceptive had a modest but significant increased risk of contracting HIV infection, according to a meta-analysis of 12 studies published in January 8 at The Lancet Infectious Diseases. However, there was no increased risk for women using birth control pills.
A number of studies over the years have examined the possibility of using hormonal contraception increases the risk of HIV infection but the results have been inconsistent with some seeing an increased risk and others not seeing the difference. The reason for this association remains unclear, but contraceptive hormones may alter vaginal delivery or cervical tissues or affect the local immune response.
Lauren Ralph, Nancy Padian and colleagues from the University of California at Berkeley School of Public Health and colleagues conducted a meta-analysis of existing data on various hormonal contraceptive methods including birth control pills and depot injectable medroxyprogesterone (DMPA or Depo-Provera ) and NET-PT enanthate norethisterone).
Construction of a previous systematic review, they searched the PubMed medical literature database for articles published between December of 2011 and June of 2014, as well as abstracts presented at International AIDS Society conferences and the annual conference on retroviruses and opportunistic infections (ends). The researchers identified a total of 26 relevant studies, 12 of which met their inclusion criteria, most of which were conducted in sub-Saharan Africa.
- The ten studies of Depo-Provera - which included a total of more than 39 500 women - showed evidence of an overall increase in risk for HIV infection among women using this method compared to other methods of contraception (pooled hazard ratio [HR] 1,40, or an increased risk of 40%).
- Looking at the 8 studies of women using Depo-Provera in the general population, the high risk of HIV was somewhat lower (pool of 1,31 HR, or an increase of 31%) than it was when including 2 studies of women at high risk of infection as sex workers and women with HIV-positive partners (the variability between these 2 studies - HR 1,73 and 3,93 - was too large to calculate an estimate pool).
- There was no evidence of increased risk of HIV infection in 10 studies of combined or only oral progestin contraceptive pills (1,00 HR pool).
- There was also no significant increase in risk seen in 5 studies of enanthate norethisterone pool HR 1.10).
"Our findings show a moderate increase in the risk of HIV acquisition for all women using depot of medroxyprogesterone acetate, with a lower increase in the risk of women in the general population," the study authors concluded. "If the risks of HIV infections observed in our studies required the complete depot withdrawal of medroxyprogesterone acetate that needs to be balanced against the known benefits of a highly effective contraceptive."
"The moderate elevation at risk observed in our study is not sufficient to justify a complete withdrawal of [Depo-Provera] for women in the general population," author Ralph stated in The Lancet media release. "Banning [Depo-Provera] would leave many women without immediate access to alternative, contraceptive is one of the effective options. This could lead to more unwanted pregnancies, and because childbirth continues to be a threat to life in many developing countries, could increase the overall level of death among women. "
In a Follow-up Comment Christopher Colvin of the University of Cape Town and Abigail Harrison of the Brown University School of Public Health discussed the controversy stemming from the conflicting research prior.
"Currently, more and more narrow aisles, and heated debates about HIV and the medroxyprogesterone acetate bond market have focused on, it would be necessary (a translator's note, for me it is clear that this is so) a large randomized trial and controlled that should be done to better understand this bond, "they wrote. "As many scientific controversies, hardened views have become, personal, financial or political agendas have been suggested, and there has even been intrigue in the form of fugue copies of peer review articles. Both sides have raised important convincing arguments, but their nonpartisan character may weaken the quality of the debates and restrict the display of the complex relationship between evidence, politics and practice. "
"Most importantly the next steps for women around the world are examining ways to expand women's contraceptive options, with control literally belonging to women (Muher is ten times more likely to contract HIV) and increase the capture of other safe and effective contraceptive methods and to intensify research on new contraceptive methods, especially those that protect against HIV and pregnancy, "said author
Senior Padian at the UC Berkeley News Center.
Note editor soropositivo.org.
Although I know that for many men and women of 30 the 2nd stop to use the other turn-off condom and I would recommend them to Bocage, with its "acid mood" ... Well, the fact is that contraceptidos not protect for nothing but the infection HIV to "only" mai a person, and I know that there KY and other lubricants, it costs me a lot (and I see the charts) believe that the current generation can succumb to the virus, leaving not only Brazil, but, on a global scale, all pessos living with HIV or AIDS, while mmencionar that would lead to a generation technique and logistically impractical and I wonder if I'm delirious for taking something they put in the water tank in the building I live.
THIS IS VERY SERIOUS, and far from remitting Cassandra's position to the Apocalypse, I am giving one more warning shot (I have already said it in the past) ... (...) ...
LJ Ralph, so McCoy, K Shiu, et al. Use of hormonal contraceptive and women's risk of HIV acquisition: A Meta-Analysis of observational studies. The Lancet of infectious diseases 3099 (14): 71052-71057. January 8 of 2015.
CJ Colvin and B Harrison. To broaden the debate on HIV and hormonal contraception (Commentary). The Lancet of infectious diseases 3099 (14): 71076. January 8 of 2015.
Study supports link between injectable hormonal contraceptives and HIV risk. The Lancet. Media advisory. January 8 of 2014.
S Yang. Study Links Birth Control Shot for moderately increased risk of HIV infection. UC Berkeley News Center. January 8 of 2014.
Originally published in 16 / 01 / 15 in Vaginal Infections May Help Explain Link Between Hormonal Contraception and HIV Increased Risk and still I found relevant translate it. Claudio Souza e Revised Mara Macedo on 1 of August of 2016
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