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Oral Contraceptive Increases HIV Risk (for both men & women)
 
 
  By Michael Smith, North American Correspondent, MedPage Today Published: October 03, 2011

"The Pill" and other hormonal methods of contraception are associated with an increased risk of acquiring HIV for both men and women, researchers reported.

An observational analysis - from a randomized trial of couples in which one partner had HIV and the other did not - found that HIV-negative women using hormonal contraception had nearly twice the risk of catching HIV as those using other methods or none, according to Jared Baeten, MD, of the University of Washington in Seattle, and colleagues.

But the study also found - for the first time - that HIV-negative male partners of women with the virus also face an increased risk if the women use hormonal methods of contraception, mainly injections of long-acting depot medroxyprogesterone acetate (DMPA), Baeten and colleagues reported online in The Lancet Infectious Diseases.

Action Points

· Explain that hormonal methods of contraception are associated with an increased risk of acquiring HIV for both men and women, according to an observational study.

· Note that the study also found that HIV-negative male partners of women with the virus face an increased risk if the women use hormonal methods of contraception, mainly injections of long-acting depot medroxyprogesterone acetate.

The study raises important public health questions and needs a randomized trial to confirm or refute the findings, the researchers concluded.

One possible implication of the findings is that promotion of DMPA contraception in Africa has inadvertently fueled the HIV/AIDS pandemic - a "tragic" situation, if true, according to Charles Morrison, PhD, and Kavita Nanda, MD, both of Family Health International in Durham, N.C.

But curtailing the use of a very effective method of contraception could have equally tragic results, they argued in an accompanying comment article - "increased maternal mortality and morbidity and more low-birth-weight babies and orphans."

They also called for a randomized trial to settle what they called a "crucial public health question."

The data come from the so-called "Partners in Prevention" study, which aimed to see if treating herpes simplex II - a common infection in sub-Saharan Africa - might reduce the risk of acquiring HIV in serodiscordant couples.

The treatment had no benefit, but Baeten and colleagues decided to examine data from the 3,790-couple trial to see if they could add anything to the debate over hormonal contraception.

They found:

· In the 1,314 couples in which the man was HIV-positive, the rate of HIV acquisition for women was 6.61 per 100 person-years if they used hormonal contraception, compared with 3.78 per 100 person-years if they did not.

· Those rates yielded an adjusted hazard ratio of 1.98,with a 95% confidence interval from 1.06 to 3.68, which was significant at P=0.03.

· The increased risk was seen for both injected and oral contraception, but the association was not significant for oral medications.

· Similarly, among the 2,476 couples in which the woman was HIV-positive, the rate of HIV transmission to the uninfected male partner was 2.61 per 100 person-years if women used hormonal contraception and 1.51 per 100 person-years if they did not.

· The difference yielded an adjusted hazard ratio of 1.97, with a 95% confidence interval from 1.12 to 3.45, which was significant at P=0.02.

· Again, while the risk associated with oral contraception was elevated, it did not reach significance.

The researchers noted that the analysis is based on observation and may have been influenced by unmeasured confounding factors. As well, they cautioned, data on contraceptive use was based on self-report and did not include information on adherence or brand.

One important strength of the study, the comment authors noted, is that "exposure to HIV was known" since the participants were serodiscordant couples and only HIV infections genetically linked to the infected partner were included in the analysis.

But they also cautioned that the study was not designed to examine the contraception issue, so that only a relatively small proportion of women used hormonal contraception and few infections occurred among them or their partners.

 
 
 
 
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