Elsevier

Contraception

Volume 90, Issue 4, October 2014, Pages 360-390
Contraception

Review article
Hormonal contraceptive methods and risk of HIV acquisition in women: a systematic review of epidemiological evidence

https://doi.org/10.1016/j.contraception.2014.07.009Get rights and content
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open access

Abstract

Whether use of various types of hormonal contraception (HC) affect risk of HIV acquisition is a critical question for women's health. For this systematic review, we identified 22 studies published by January 15, 2014 which met inclusion criteria; we classified thirteen studies as having severe methodological limitations, and nine studies as “informative but with important limitations”. Overall, data do not support an association between use of oral contraceptives and increased risk of HIV acquisition. Uncertainty persists regarding whether an association exists between depot-medroxyprogesterone acetate (DMPA) use and risk of HIV acquisition. Most studies suggested no significantly increased HIV risk with norethisterone enanthate (NET-EN) use, but when assessed in the same study, point estimates for NET-EN tended to be larger than for DMPA, though 95% confidence intervals overlapped substantially. No data have suggested significantly increased risk of HIV acquisition with use of implants, though data were limited. No data are available on the relationship between use of contraceptive patches, rings, or hormonal intrauterine devices and risk of HIV acquisition. Women choosing progestin-only injectable contraceptives such as DMPA or NET-EN should be informed of the current uncertainty regarding whether use of these methods increases risk of HIV acquisition, and like all women at risk of HIV, should be empowered to access and use condoms and other HIV preventative measures. Programs, practitioners, and women urgently need guidance on how to maximize health with respect to avoiding both unintended pregnancy and HIV given inconclusive or limited data for certain HC methods.

Keywords

Hormonal contraception
DMPA
Injectable contraception
Oral contraception
HIV acquisition
Systematic review

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Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the United States Agency for International Development, the Centers for Disease Control and Prevention, or the World Health Organization.