Women who use the injectable contraceptive Depo-Provera long action had a modest but significant increase in the risk of HIV infection, according to a study based on the data collection 12 studies published inJanuary 8Lancet 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 the use of hormonal contraception increase the risk of HIV infection, but the results have been inconsistent, with some seeing an increased risk and others do not see the difference. The reason for this association remains unclear, but contraceptive hormones can change the intra-vaginal or cervical tissue environment or affect the immune response in the vaginal area.
Lauren Ralph, Nancy Padian and colleagues at the University of California at Berkeley, the School of Public Health and colleagues conducted an analysis of existing studies, collecting data on various hormonal contraception, including administered birth control methods in tablets and the deposit injectables such as Depo-Provera and norethisterone enanthate NET-EN).
Construction of a previous systematic review, they searched the medical database of literature for articles published between December 2011 and June 2014 and abstracts presented at the International AIDS Society conferences and the annual conference on retroviruses and opportunistic infections (CROI) . 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 over 39 500 women - showed evidence of an overall increase of risk for HIV infection among women using this method compared with other methods of contraception 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 slightly lower, showing an increase of 31% of what it was when they were included in the studies of women at high risk of infection such as sex workers and women with HIV-positive partners (2 variability among these studies - HR 1,73 and 3,93 - was too large for calculating an estimated pool).
- There was no evidence of increased risk of HIV infection in ten studies of combination therapies or using only oral contraceptive pills (pooled HR 1,00).
- There was also no significant increase in risk seen in studies 5 norethisterone enanthate.
"Our findings show a moderate increase in the risk of HIV acquisition for all women using depot medroxyprogesterone acetate, with a smaller increase in the risk of women in the general population," the study authors concluded. "If the risk of contracting HIV observed in our studies would be suitable for depot medroxyprogesterone acetate withdrawal that must be balanced in relation to the known benefits of a highly effective contraceptive."
"The moderate rise in risk observed in our study is not sufficient to justify a complete withdrawal of Depo-Provera for women in the general population," author Ralph said inIn The LancetMedia release. "The prohibition of Depo-Provera would leave many women without immediate access to effective contraceptive alternative options. This is likely to lead to more unwanted pregnancies, and because childbirth remains a threat to life in many developing countries could increase the overall level of deaths among women. "
On aAccompanying CommentChristopher Colvin of the University of Cape Town and Abigail Harrison Brown University School of Public Health discussed the controversy arising from conflicting research.
"Currently, the increasingly narrow access to debates about HIV and the link between medroxyprogesterone acetate have focused on the need to make a large controlled study should be done to better understand this relationship," they wrote. "Like many scientific controversies, visions has made hardened, personal, financial or linked to suggested political agendas, and there was even intrigue in the form of escape copies of peer-reviewed articles. Both sides have raised important convincing arguments, but its non-partisan nature can weaken the quality of debate and restrict the display of the complex relationship between evidence, policy and practice. "
"The most important is that the next steps are made for the benefit of women around the world in order to examine ways of increasing women's contraceptive options and increase the uptake of other contraceptive safe and effective methods and to intensify research on new contraceptive methods, especially those that protect against HIV and pregnancy, "senior author Padian told News Center at UC Berkeley.
Translated by Claudio Souza the originalMeta-Analysis Shows Injectable Hormonal Contraception Linked to HIV Infection Riskin 11 / 05 / 2016
reviewed by Mara Macedo
Editor's note: I have a theory that it would be difficult to prove true or false:
I think the girls making use of birth control that they feel "safe" with respect to pregnancy and they forget
LJ Ralph, as McCoy, K Shiu et al. Use of hormonal contraceptives and women the risk of HIV acquisition: A Meta-Analysis of observational studies.The Lancet Infectious Diseases3099 (14): 71052-71057. 8 January 2015.
Colvin and B Harrison CJ. To broaden the debate on HIV and hormonal contraception (Review).The Lancet Infectious Diseases3099 (14): 71076. 8 January 2015.
Study supports link between injectable hormonal contraceptives and HIV risk.Lancet.Media advisory. 8 January 2014.
S Yang. Birth Control Shot Study links to moderately increased risk of HIV infection.UC Berkeley News Center. 8 January 2014.