Hormonal contraception and HIV: hormonal contraceptive users need not switch to another contraceptive method.(Clinical report)

Hormonal contraceptive methods, among the most effective means of preventing pregnancy, have greatly improved the well-being of women and their families alike. However, as the HIV/AIDS pandemic continues unabated, scientists seeking to identify factors that could contribute to the spread of HIV have raised the possibility of an association between hormonal contraceptive use and HIV acquisition.

Research on the topic has been conflicting and inconclusive. However, new data from the largest prospective study ever conducted specifically on this topic help clarify this issue. The FHI-led investigation, conducted among family planning clients in Uganda, Zimbabwe, and Thailand, has found no overall association between the use of combined oral contraceptive (COC) pills or depot-medroxyprogesterone acetate (DMPA) and HIV acquisition. In sum, on the basis of current knowledge about HIV acquisition risks, hormonal contraceptive users who are HIV-negative need not switch to another contraceptive method.

Despite its sophistication and power, this study--funded by the U.S. National Institute of Child Health and Human Development--raised an interesting and unexpected question (see article, page 4): Does the absence of previous genital herpes infection influence the impact, if any, of hormonal contraception on HIV acquisition? Further analyses of the rich data from this study may help provide answers.

Meanwhile, hormonal contraceptive use by HIV-infected women continues to be an important topic for researchers. More women worldwide are learning that they are infected with HIV and many of them do not wish to become pregnant. Uncertainty exists about whether the use of hormonal contraception by HIV-positive women affects their infectivity to male partners or disease progression to AIDS. Research about the infectiousness of HIV-positive hormonal contraceptive users has been limited and inconclusive. As a result, the topic continues to be investigated.

Likewise, some evidence indicates that disease progression may be more rapid if hormonal contraception is used at the time of HIV infection than if it is not used then, but this observation must be confirmed. Further research will also help determine whether hormonal contraceptive use during the later, chronic stage of HIV infection alters the progression to AIDS and the need for antiretroviral (ARV) drug therapy. Finally, clarity about interactions between hormonal contraception and ARV therapy (or other medications used to treat AIDS-related opportunistic infections) is needed. HIV treatment programs are currently scaling up in countries with high HIV prevalence among women, so we need this knowledge as soon as possible.

While hormonal contraception is highly effective against pregnancy, it does not protect against HIV. Thus, HIV-negative hormonal contraceptive users at any risk of infection should, if possible, reduce their number of sex partners and also use condoms consistently and correctly. This long-accepted recommendation remains unchanged regardless of the method of contraception a woman uses. If further research confirms that hormonal ...