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AIDS. 2019 Aug 1;33(10):1619-1622. doi: 10.1097/QAD.0000000000002260.

Risk of HIV-1 acquisition among South African women using a variety of contraceptive methods in a prospective study.

Author information

1
Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa.
2
Fred Hutchinson Cancer Research Center.
3
University of Washington, Seattle, Washington, USA.
4
Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda.
5
South African Medical Research Council.
6
Centre for the AIDS Programme of Research in South Africa, Durban.
7
University of Cape Town, Cape Town, South Africa.
8
National Institutes of Health, Bethesda, Maryland.
9
University of Pittsburgh, Pittsburgh, Pennsylvania, USA.

Abstract

OBJECTIVE:

Observational studies have associated use of intramuscular injectable depot medroxyprogesterone acetate (DMPA-IM) with increased risk of HIV-1 acquisition, but limited data are available to assess HIV-1 risk for alternate contraceptive methods.

METHODS:

Within a randomized trial of the dapivirine vaginal ring for HIV-1 prevention, we assessed HIV-1 incidence by contraceptive method. We limited analyses to participants from South African sites and to women who used DMPA-IM, the alternative injectable norethisterone enanthate, implants, or copper intrauterine devices (IUDs). Contraceptive method was assessed as a time-dependent exposure and multivariate models adjusted for trial randomization arm, age, sexual behaviour, and incident sexually transmitted infections.

RESULTS:

A total of 95 incident HIV-1 infections were observed: incidence 5.8 (DMPA-IM, n = 52), 6.2 (norethisterone enanthate, n = 28), 1.9 (implant, n = 3), and 4.5 (IUD, n = 12) cases per 100 woman-years. In multivariable models, there were no statistically significant differences between contraceptive methods in the risk of HIV-1 acquisition. However, compared with the IUD, the three hormonal methods each had point estimates near 1 while the implant had risk that was approximately half that of the IUD. When the three hormonal methods were combined, their relative risk compared with IUD was 0.90 (95% confidence interval 0.45-1.76).

CONCLUSION:

Among women at risk of HIV-1 infections in South Africa, we found no statistically significant differences in HIV-1 incidence by contraceptive method. Implants had the lowest point estimate for HIV-1 incidence, and IUDs had risk comparable with injectable methods in multivariate models. Large, prospective studies are needed to define better the relative HIV-1 risks across different contraceptive methods.

PMID:
31306167
PMCID:
PMC6636847
[Available on 2020-08-01]
DOI:
10.1097/QAD.0000000000002260

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