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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Use of hormonal contraceptives and risk of HIV-1 transmission: A prospective cohort study
The Lancet Infectious Diseases, Volume 12, No. 1, Year 2012
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Description
Background: Hormonal contraceptives are used widely but their effects on HIV-1 risk are unclear. We aimed to assess the association between hormonal contraceptive use and risk of HIV-1 acquisition by women and HIV-1 transmission from HIV-1-infected women to their male partners. Methods: In this prospective study, we followed up 3790 heterosexual HIV-1-serodiscordant couples participating in two longitudinal studies of HIV-1 incidence in seven African countries. Among injectable and oral hormonal contraceptive users and non-users, we compared rates of HIV-1 acquisition by women and HIV-1 transmission from women to men. The primary outcome measure was HIV-1 seroconversion. We used Cox proportional hazards regression and marginal structural modelling to assess the effect of contraceptive use on HIV-1 risk. Findings: Among 1314 couples in which the HIV-1-seronegative partner was female (median follow-up 18·0 [IQR 12·6-24·2] months), rates of HIV-1 acquisition were 6·61 per 100 person-years in women who used hormonal contraception and 3·78 per 100 person-years in those who did not (adjusted hazard ratio 1·98, 95% CI 1·06-3·68, p=0·03). Among 2476 couples in which the HIV-1-seronegative partner was male (median follow-up 18·7 [IQR 12·8-24·2] months), rates of HIV-1 transmission from women to men were 2·61 per 100 person-years in couples in which women used hormonal contraception and 1·51 per 100 person-years in couples in which women did not use hormonal contraception (adjusted hazard ratio 1·97, 95% CI 1·12-3·45, p=0·02). Marginal structural model analyses generated much the same results to the Cox proportional hazards regression. Interpretation: Women should be counselled about potentially increased risk of HIV-1 acquisition and transmission with hormonal contraception, especially injectable methods, and about the importance of dual protection with condoms to decrease HIV-1 risk. Non-hormonal or low-dose hormonal contraceptive methods should be considered for women with or at-risk for HIV-1. Funding: US National Institutes of Health and the Bill & Melinda Gates Foundation. © 2012 Elsevier Ltd.
Authors & Co-Authors
Heffron, Renee A.
United States, Seattle
University of Washington
Donnell, Deborah J.
United States, Seattle
Fred Hutchinson Cancer Research Center
Rees, Helen V.
South Africa, Johannesburg
University of the Witwatersrand Faculty of Health Sciences
Celum, Connie L.
United States, Seattle
University of Washington
Mugo, Nelly Rwamba
United States, Seattle
University of Washington
Kenya, Nairobi
Kenyatta National Hospital
Kenya, Nairobi
University of Nairobi
Were, Edwin O.
Kenya, Eldoret
Moi University
De Bruyn, Guy
South Africa, Johannesburg
University of the Witwatersrand
Nakku-Joloba, Edith
Uganda, Kampala
Makerere University College of Health Sciences
Uganda, Kampala
Mulago Hospital
Ngure, Kenneth K.
Kenya, Nairobi
Kenyatta National Hospital
Kiarie, James Njogu
United States, Seattle
University of Washington
Kenya, Nairobi
Kenyatta National Hospital
Kenya, Nairobi
University of Nairobi
Coombs, Robert W.
United States, Seattle
University of Washington
Baeten, Jared M.
United States, Seattle
University of Washington
Statistics
Citations: 432
Authors: 12
Affiliations: 9
Identifiers
Doi:
10.1016/S1473-3099(11)70247-X
ISSN:
14733099
e-ISSN:
14744457
Research Areas
Environmental
Health System And Policy
Infectious Diseases
Sexual And Reproductive Health
Study Design
Cohort Study
Study Approach
Quantitative
Participants Gender
Male
Female