Jennifer Deese1,2, Lindi Masson3,4, William Miller5, Myron Cohen5, Charles Morrison1, Meng Wang6, Khatija Ahmed7, Kawango Agot8, Tania Crucitti9, Saïd Abdellati9, Lut Van Damme10. 1. FHI 360, Durham, NC, USA. 2. Department of Epidemiology, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 3. Division of Medical Virology, Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa. 4. Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa. 5. Division of Infectious Diseases, Department of Medicine, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. 6. CROS NT LLC, Chapel Hill, NC, USA. 7. Setshaba Research Centre, Soshanguve, Pretoria, South Africa. 8. Impact Research and Development Organization, Kisumu, Kenya. 9. Institute of Tropical Medicine, Antwerp, Belgium. 10. The Bill & Melinda Gates Foundation, Seattle, WA, USA.
Abstract
PROBLEM: Genital inflammatory changes may be a mechanism of increased HIV risk among injectable progestin-only contraception (IPC) users. METHOD OF STUDY: We conducted a cross-sectional analysis of 376 Kenyan and South African women. Genital cytokines and secretory leukocyte peptidase inhibitor concentrations in a reference population were compared to IPC users and women with reproductive tract infections. RESULTS: No significant variability in marker concentrations was observed by age or site. Depot medroxyprogesterone acetate (DMPA) users had significantly higher MIP-1α, MIP-1β, IL-6, IL-8, IP-10, and RANTES concentrations. Norethisterone oenanthate users had significantly higher IL-6, IL-8, and RANTES concentrations. Women with sexually transmitted infections had variable inflammation, and women with bacterial vaginosis exhibited a mixed profile of up and downregulation. CONCLUSION: The finding of substantial mucosal inflammation among DMPA users provides evidence which, combined with the results of prior studies, suggests that DMPA may create an immune environment conducive to HIV target cell recruitment and inhibitory for antiviral activity.
PROBLEM: Genital inflammatory changes may be a mechanism of increased HIV risk among injectable progestin-only contraception (IPC) users. METHOD OF STUDY: We conducted a cross-sectional analysis of 376 Kenyan and South African women. Genital cytokines and secretory leukocyte peptidase inhibitor concentrations in a reference population were compared to IPC users and women with reproductive tract infections. RESULTS: No significant variability in marker concentrations was observed by age or site. Depot medroxyprogesterone acetate (DMPA) users had significantly higher MIP-1α, MIP-1β, IL-6, IL-8, IP-10, and RANTES concentrations. Norethisterone oenanthate users had significantly higher IL-6, IL-8, and RANTES concentrations. Women with sexually transmitted infections had variable inflammation, and women with bacterial vaginosis exhibited a mixed profile of up and downregulation. CONCLUSION: The finding of substantial mucosal inflammation among DMPA users provides evidence which, combined with the results of prior studies, suggests that DMPA may create an immune environment conducive to HIV target cell recruitment and inhibitory for antiviral activity.