Tagged: hormonal contraception

  • January 22, 2015

    Exploring the potential link between hormonal contraceptive use and HIV acquisition

    Written by
    Charles Morrison, Director of Clinical and Epidemiological Sciences, FHI 360

    morrison_charles_2012_220x200Are women who take hormonal contraceptives at an increased risk of acquiring HIV? If so, do some contraceptives put women at higher risk than others?

    This week, the influential health journal, PLOS Medicine, published the results of a large individual-participant data meta-analysis, authored by FHI 360 and collaborators, that seeks to answer these questions.

    While this issue matters to the field of reproductive health, it is especially critical to women in East and Southern Africa. In these regions, women potentially have a double risk factor: high rates of HIV and high use of hormonal contraception, particularly depot-medroxyprogesterone acetate (DMPA), a type of contraceptive that is injected every three months. So far, the evidence on DMPA shows that it is the hormonal contraceptive that has the most potential to increase HIV acquisition; however, the evidence is inconclusive.

    FHI 360’s meta-analysis combines the results of 18 prospective studies, including more than 37,000 women, of whom more than 1,800 became infected with HIV. We found that women who used DMPA had a 50 percent increased risk of HIV acquisition compared with women who did not use hormonal contraceptives. We found no significant increase in HIV risk among women using combined oral contraceptives (COCs) or norethisterone enanthate (Net-En), a contraceptive injected every two months. Women using DMPA also had an increased HIV risk when compared directly with COC or Net-En users.

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  • December 18, 2014

    Can women living with HIV and taking antiretroviral therapy use hormonal contraceptive methods?

    Written by
    Chelsea Polis, Senior Research Associate, Guttmacher Institute
    Kavita Nanda, Senior Medical Scientist, Contraceptive Technology Innovation Department, FHI 360

    Extraordinary gains have been made in the last decade toward increasing access to antiretroviral therapy (ART) for HIV. With an eye toward ending the AIDS epidemic by 2030, UNAIDS recently released bold targets related to HIV diagnosis and treatment. By the year 2020, their aim is to have 90 percent of all people living with HIV aware of their status, 90 percent of people diagnosed with HIV receiving sustained ART and 90 percent of people on ART achieving viral suppression. As we move closer to these laudable public health goals, we must also consider how expansion of ART may affect and be affected by other health issues, such as prevention of unintended pregnancy among women living with HIV.

    An increasingly important issue is whether certain ART regimens are expected to have drug interactions when used with certain hormonal contraceptive methods. In theory, an interaction could affect the efficacy of either medication or cause side effects or toxicity. If contraceptive efficacy decreases, the chances of contraceptive failure, unintended pregnancy and the accompanying consequences increase. A decrease in ART efficacy could lead to treatment failure, viral resistance and greater likelihood of subsequent HIV transmission. Increases in side effects or toxicity can affect quality of life and medication adherence. Yet, despite the importance of this issue, relatively few studies (particularly those with clinical outcomes such as ovulation, pregnancy or treatment failure) have been conducted.

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