Hormonal Contraception and HIV Acquisition: The Latest

1
Hormonal Contraception and HIV Acquisition The
Latest

• Willard Cates, Jr., MD, MPH
• Family Health International
• FP HIV/AIDS Integration Meeting
• November 3, 2005

2
Hormones and HIV Possible Mechanisms

• Vaginal and cervical epithelium (ectopy, etc.)
• Cervical mucus
• Menstrual patterns
• Vaginal and cervical immunology
• Viral (HIV) replication
• Acquisition of other STI

3
HC/HIV Evidence

• COCs
• 9 cohort studies
• 28 cross-sectional studies
• 1 meta-analysis and 1 systematic review
• DMPA
• 14 cross-sectional studies
• 4 cohort studies
• 1 systematic review
• Other hormonal methods
• No studies

Source Curtis (2003)
4
Problems HC/HIV Evidence

• Number of HC users low
• Comparability of groups not assessed
• Crude measurement of exposure
• Timing of HC and HIV unclear
• Inappropriate comparison group
• Poor follow-up
• Poor generalizability

5
WHO MEC Conclusions

• Intermediate level of evidence
• No increased risk among COC
• Mixed risk for DMPA
• Await results from NICHD/FHI study

Source Mohllajee and Curtis (2003)
6
Hormonal Contraception and the Risk of HIV
Acquisition
7
Hormonal Contraception and the Risk of HIV
Acquisition
8
Incident HIV and STI by Site
9
African Study Participants
10
HC/HIV Dissemination
11
HC/HIV Data Implications

• Encouraging findings overall
• Point estimates lower than other well-done
  studies
• No significant association HC/HIV
• Surprising subgroup results HSV-neg
• Many possible explanations
• Needs confirmation
• No change in WHO or IPPF Guidelines