6th IAS Conference On HIV Pathogenesis, Treatment and Prevention


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WEAX0206 - Oral Abstract Session

Hormonal contraceptive use and risk of HIV-1 transmission: a prospective cohort analysis

Presented by Renee Heffron (United States).

R. Heffron1, D. Donnell2, H. Rees3, C. Celum4, E. Were5, N. Mugo6, G. de Bruyn7, E. Nakku-Joloba8, K. Ngure6, J. Kiarie6, J. Baeten4, Partners in Prevention HSV/HIV Transmission team

1University of Washington, Epidemiology, Global Health, Seattle, United States, 2Fred Hutchinson Cancer Research Center, Seattle, United States, 3University of the Witwatersrand, Reproductive Health Research Unit, Johannesburg, South Africa, 4University of Washington, Global Health, Medicine and Epidemiology, Seattle, United States, 5Moi University, Reproductive Health, Eldoret, Kenya, 6Kenyatta National Hospital, Nairobi, Kenya, 7University of the Witwatersrand, Perinatal HIV Research Unit, Soweto, South Africa, 8New Malago Hospital, Kampala, Uganda

Background: Hormonal contraception, including daily oral pills and long-acting injectable methods, are used widely but their effects on HIV-1 risk are unclear.
Methods: We prospectively followed 3790 heterosexual HIV-1 serodiscordant couples (in which one partner was HIV-1 seropositive and the other seronegative) from 7 African countries for up to 24 months. Among hormonal contraceptive users and nonusers, we compared rates of HIV-1 acquisition in women and HIV-1 transmission from women to men using multivariate Cox proportional hazards regression and marginal structural modeling.
Results: Among 1314 couples in which the HIV-1 seronegative partner was female, HIV-1 acquisition rates were 6.61 and 3.78 per 100 person-years in women currently using and not using hormonal contraception (adjusted hazard ratio [HR] 1.98, 95% confidence interval [CI] 1.06-3.68, p=0.03). Among 2476 couples in which the HIV-1 seronegative partner was male, HIV-1 transmission rates from women to men were 2.61 and 1.51 per 100 person-years in those whose partners currently used versus did not use hormonal contraception (adjusted HR 1.97, 95% CI 1.12-3.45, p=0.02). Both injectable and oral hormonal contraceptive methods were associated with increased HIV-1 risk, although subgroup analyses were statistically significant only for injectable contraception. Results from marginal structural model analyses were consistent with those from the Cox proportional hazards regression. Genital HIV-1 RNA concentrations were significantly higher in HIV-1 seropositive women using hormonal contraception than those using no contraception, suggesting a potential mechanism for increased transmission risk from women to men.
Conclusion: Women should be counseled about potential increased risk of HIV-1 acquisition and transmission with hormonal contraception, particularly injectable methods, and about the importance of dual protection with condoms to decrease HIV-1 risk. Strategies to encourage use of long-acting contraceptive methods with lower doses of exogenous hormones or non-hormonal methods (i.e. intrauterine devices) should be promoted.

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