Risk of HIV-1 acquisition among South African women using a variety of contraceptive methods in a prospective study
Year: 2019
Type: article
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.
Source: AIDS
Institutions: University of the Witwatersrand, University of Washington, Fred Hutch Cancer Center, MUJHU Research Collaboration, South African Medical Research Council, Centre for the AIDS Programme of Research in South Africa, University of Cape Town, National Institutes of Health, University of Pittsburgh
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
Awards: Microbicide Trials Network, Statistical and Data Management Center (SDMC): Microbicide Trials Network, Leadership and Operations Center (LOC): Microbicide Trials Network, Units for HIV/AIDS Clinical Trials Networks, Laboratory Center (LC): Microbicide Trials Network, The Johns Hopkins University - Uganda Clinical Trials Unit, Wits HIV Research Group CLINICAL TRIAL UNIT (CTU) reapplication, KwaZulu-Natal Clinical Trials Unit
OpenAlex ID: W2945565377