Hormonal contraception and HIV acquisition among women: an updated systematic review

Kathryn M Curtis, Philip C Hannaford, Maria Isabel Rodriguez, Tsungai Chipato, Petrus S Steyn, James N Kiarie

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Abstract

OBJECTIVE: To update a 2016 systematic review on hormonal contraception use and HIV acquisition.

METHODS: We searched Pubmed and Embase between 15 January 2016 and 26 June 2019 for longitudinal studies comparing incident HIV infection among women using a hormonal contraceptive method and either non-users or users of another specific hormonal contraceptive method. We extracted information from newly identified studies, assessed study quality, and updated forest plots and meta-analyses.

RESULTS: In addition to 31 previously included studies, five more were identified; three provided higher quality evidence. A randomised clinical trial (RCT) found no statistically significant differences in HIV risk among users of intramuscular depot medroxyprogesterone acetate (DMPA-IM), levonorgestrel implant (LNG implant) or the copper intrauterine device (Cu-IUD). An observational study found no statistically significant differences in HIV risk among women using DMPA, norethisterone enanthate (NET-EN), implants (type not specified) or Cu-IUD. Updated results from a previously included observational study continued to find a statistically significant increased HIV risk with oral contraceptives and DMPA compared with no contraceptive use, and found no association between LNG implant and HIV risk.

CONCLUSIONS: High-quality RCT data comparing use of DMPA, LNG implant and Cu-IUD does not support previous concerns from observational studies that DMPA-IM use increases the risk of HIV acquisition. Use of other hormonal contraceptive methods (oral contraceptives, NET-EN and implants) is not associated with an increased risk of HIV acquisition.

Original languageEnglish
Pages (from-to)8-16
Number of pages9
JournalAfrican Journal of Reproductive Health
Volume46
Issue number1
Early online date9 Jan 2020
DOIs
Publication statusPublished - Jan 2020

Keywords

  • AFRICAN WOMEN
  • RISK
  • METAANALYSIS

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    Curtis, K. M., Hannaford, P. C., Rodriguez, M. I., Chipato, T., Steyn, P. S., & Kiarie, J. N. (2020). Hormonal contraception and HIV acquisition among women: an updated systematic review. African Journal of Reproductive Health, 46(1), 8-16. https://doi.org/10.1136/bmjsrh-2019-200509