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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Hormonal contraception and the risk of HIV acquisition among women in South Africa
AIDS, Volume 26, No. 4, Year 2012
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Description
Objectives: To evaluate the effect of hormonal contraception including combined oral contraceptives (COCs), and the injectable progestins depo-medroxyprogesterone acetate (DMPA) and norethisterone enanthate (Net-En) on the risk of HIV acquisition among women in South Africa. DESIGN/Methods: We analyzed data from 5567 women aged 16-49 years participating in the Carraguard Phase 3 Efficacy Trial. Participants were interviewed about contraceptive use and sexual behaviors and underwent pelvic examinations and HIV testing quarterly. We used marginal structural Cox regression models to estimate the effect of hormonal contraception exposure on HIV acquisition risk among women overall and among young women (16-24 years) in particular. Results: Two hundred and seventy participants became HIV-infected (3.7 per 100 woman-years); HIV incidence was 2.8, 4.6, 3.5 and 3.4 per 100 woman-years in the COC, DMPA, Net-En and nonhormonal contraceptive groups, respectively (P=0.09). The adjusted hazard ratios (AHRs) were 0.84 [95% confidence interval (CI) 0.51-1.39], 1.28 (95% CI 0.92-1.78) and 0.92 (95% CI 0.64-1.32) among COC, DMPA and Net-En users, respectively, compared with the nonhormonal group controlling for covariates. Age modified the effect of hormonal contraception on HIV acquisition risk; among young women, the AHRs were 1.02 (95% CI 0.46-2.28) for COCs, 1.68 (95% CI 0.96-2.94) for DMPA and 1.36 (95% CI0.78-2.35) for Net-En users. Conclusions: In this study conducted among South African women, hormonal contraception did not significantly increase the risk of HIV acquisition. However, the effect estimate does not rule out a moderate increase in HIV risk associated with DMPA use found in some other recent studies. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Authors & Co-Authors
Morrison, Charles S.
United States, Durham
Fhi 360
Skoler-Karpoff, Stephanie
United States, New York
Memorial Sloan-kettering Cancer Center
United States, New York
The Population Council, Inc.
Kwok, Cynthia
United States, Durham
Fhi 360
Chen, Pai Lien
United States, Durham
Fhi 360
van de Wijgert, Janneke H.H.M.
United States, New York
The Population Council, Inc.
Netherlands, Amsterdam
Universiteit Van Amsterdam
Plagianos, Marlena Gehret
United States, New York
The Population Council, Inc.
Patel, Smruti
South Africa, Cape Town
University of Cape Town
Ahmed, Khatija
South Africa, Pretoria
Sefako Makgatho Health Sciences University Smu
Ramjee, Gita A.
South Africa, Tygerberg
South African Medical Research Council
Friedland, Barbara A.
United States, New York
The Population Council, Inc.
Lähteenmäki, Pekka L.A.
United States, New York
The Population Council, Inc.
Finland, Helsinki
Helsingin Yliopisto
Statistics
Citations: 96
Authors: 11
Affiliations: 8
Identifiers
Doi:
10.1097/QAD.0b013e32834fa13d
e-ISSN:
14735571
Research Areas
Environmental
Health System And Policy
Infectious Diseases
Sexual And Reproductive Health
Study Design
Cohort Study
Study Locations
South Africa
Participants Gender
Female