Women using the long-acting injectable Depo-Provera contraceptive had a modest but significantly increased risk of contracting HIV infection, according to a study based on data collection from 12 studies published in January 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 using hormonal contraception to increase the risks 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 the intra-vaginal environment or cervical tissues or affect the immune response in the vaginal region.
Lauren Ralph, Nancy Padian and colleagues at the University of California at Berkeley, School of Public Health and colleagues, conducted an analysis of existing studies, collecting data on various hormonal contraceptive methods, including birth control methods given in tablets and the depot of injectable products such as Depo-Provera and NET-PT enanthate norethisterone).
Construction of a previous systematic review, they searched the medical database literature for articles published between 2011 and June of 2014 December, as well as abstracts presented at conferences of the International AIDS Society 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 more than 39 500 women - showed evidence of an overall increased risk for HIV infection among women using this method compared to 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 somewhat lower, revealing an increase of 31% than it was when studies of women at high risk of infection were included 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 ten studies of combined therapies or only use of oral contraceptive pills (HR 1,00 pool).
- There was also no significant increase in risk seen in 5 studies of enanthate norethisterone.
"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. "Whether the risks of contracting HIV observed in our studies would be adequate depot withdrawal of medroxyprogesterone acetate that needs to be balanced against the known benefits of a highly effective contraceptive."
"The moderate elevation of risk observed in our study is not sufficient to warrant a complete withdrawal of Depo-Provera to women in the general population," author Ralph stated in In The Lancet media release. "The ban on Depo-Provera would leave many women without immediate access to effective contraceptive alternatives. This is likely to 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 deaths among women. "
In a Accompanying 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 conflicting research.
"Nowadays, increasingly narrow access to HIV debates and the link between medroxyprogesterone acetate has focused on the need for a large, controlled study that should be done to better understand this link," they wrote. "Like many scientific controversies, visions have become hardened, personal, financial, or tied to suggested political agendas, and there has even been intrigue in the form of a drain of copies of peer-reviewed articles. Both sides have raised important compelling arguments, but their nonpartisan character may weaken the quality of debates and restrict the display of the complex relationship between evidence, politics and practice. "
"What is most important is that the next steps should be taken to benefit women around the world in order to examine ways to expand women's contraceptive options and increase the availability of other safe and effective contraceptive methods and to research on new contraceptive methods, especially those that protect against HIV and pregnancy, "senior author Padian told the UC Berkeley News Center.
Translated by Claudio Souza the original Meta-Analysis Shows Injectable Hormonal Contraception Linked to HIV Infection Risk in 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, 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.