TY - JOUR
T1 - Hormonal contraception and HIV acquisition among women
T2 - An updated systematic review
AU - Curtis, Kathryn M.
AU - Hannaford, Philip C.
AU - Rodriguez, Maria Isabel
AU - Chipato, Tsungai
AU - Steyn, Petrus S.
AU - Kiarie, James N.
N1 - Publisher Copyright:
© 2020 Author(s).
PY - 2020/1/1
Y1 - 2020/1/1
N2 - 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.
AB - 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.
KW - epidemiology
KW - hormonal contraception
KW - human immunodeficiency virus
KW - intrauterine devices
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U2 - 10.1136/bmjsrh-2019-200509
DO - 10.1136/bmjsrh-2019-200509
M3 - Review article
C2 - 31919239
AN - SCOPUS:85077720654
SN - 2515-1991
VL - 46
SP - 8
EP - 16
JO - BMJ Sexual and Reproductive Health
JF - BMJ Sexual and Reproductive Health
IS - 1
ER -