Thesla Palanee-Phillips1, Elizabeth R Brown2,3, Daniel Szydlo2, Flavia Matovu Kiweewa4, Arendevi Pather5, Ishana Harkoo6, Gonasagrie Nair7, Lydia Soto-Torres8, Sharon L Hillier3,9, Jared M Baeten3. 1. Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa. 2. Fred Hutchinson Cancer Research Center. 3. University of Washington, Seattle, Washington, USA. 4. Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda. 5. South African Medical Research Council. 6. Centre for the AIDS Programme of Research in South Africa, Durban. 7. University of Cape Town, Cape Town, South Africa. 8. National Institutes of Health, Bethesda, Maryland. 9. University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Abstract
OBJECTIVE: Observational studies have associated use of intramuscular injectable depot medroxyprogesterone acetate (DMPA-IM) with increased risk of HIV-1 acquisition, but limited data are available to assess HIV-1 risk for alternate contraceptive methods. METHODS: Within a randomized trial of the dapivirine vaginal ring for HIV-1 prevention, we assessed HIV-1 incidence by contraceptive method. We limited analyses to participants from South African sites and to women who used DMPA-IM, the alternative injectablenorethisterone enanthate, implants, or copper intrauterine devices (IUDs). Contraceptive method was assessed as a time-dependent exposure and multivariate models adjusted for trial randomization arm, age, sexual behaviour, and incident sexually transmitted infections. RESULTS: A total of 95 incident HIV-1 infections were observed: incidence 5.8 (DMPA-IM, n = 52), 6.2 (norethisterone enanthate, n = 28), 1.9 (implant, n = 3), and 4.5 (IUD, n = 12) cases per 100 woman-years. In multivariable models, there were no statistically significant differences between contraceptive methods in the risk of HIV-1 acquisition. However, compared with the IUD, the three hormonal methods each had point estimates near 1 while the implant had risk that was approximately half that of the IUD. When the three hormonal methods were combined, their relative risk compared with IUD was 0.90 (95% confidence interval 0.45-1.76). CONCLUSION: Among women at risk of HIV-1 infections in South Africa, we found no statistically significant differences in HIV-1 incidence by contraceptive method. Implants had the lowest point estimate for HIV-1 incidence, and IUDs had risk comparable with injectable methods in multivariate models. Large, prospective studies are needed to define better the relative HIV-1 risks across different contraceptive methods.
RCT Entities:
OBJECTIVE: Observational studies have associated use of intramuscular injectable depot medroxyprogesterone acetate (DMPA-IM) with increased risk of HIV-1 acquisition, but limited data are available to assess HIV-1 risk for alternate contraceptive methods. METHODS: Within a randomized trial of the dapivirine vaginal ring for HIV-1 prevention, we assessed HIV-1 incidence by contraceptive method. We limited analyses to participants from South African sites and to women who used DMPA-IM, the alternative injectable norethisterone enanthate, implants, or copper intrauterine devices (IUDs). Contraceptive method was assessed as a time-dependent exposure and multivariate models adjusted for trial randomization arm, age, sexual behaviour, and incident sexually transmitted infections. RESULTS: A total of 95 incident HIV-1 infections were observed: incidence 5.8 (DMPA-IM, n = 52), 6.2 (norethisterone enanthate, n = 28), 1.9 (implant, n = 3), and 4.5 (IUD, n = 12) cases per 100 woman-years. In multivariable models, there were no statistically significant differences between contraceptive methods in the risk of HIV-1 acquisition. However, compared with the IUD, the three hormonal methods each had point estimates near 1 while the implant had risk that was approximately half that of the IUD. When the three hormonal methods were combined, their relative risk compared with IUD was 0.90 (95% confidence interval 0.45-1.76). CONCLUSION: Among women at risk of HIV-1 infections in South Africa, we found no statistically significant differences in HIV-1 incidence by contraceptive method. Implants had the lowest point estimate for HIV-1 incidence, and IUDs had risk comparable with injectable methods in multivariate models. Large, prospective studies are needed to define better the relative HIV-1 risks across different contraceptive methods.
Authors: Lisa M Noguchi; Jeanne M Marrazzo; Barbara Richardson; Sharon L Hillier; Jennifer E Balkus; Thesla Palanee-Phillips; Gonasagrie Nair; Ravindre Panchia; Jeanna Piper; Kailazarid Gomez; Gita Ramjee; Z Mike Chirenje Journal: Front Reprod Health Date: 2021-07-16
Authors: Kathryn M Curtis; Philip C Hannaford; Maria Isabel Rodriguez; Tsungai Chipato; Petrus S Steyn; James N Kiarie Journal: BMJ Sex Reprod Health Date: 2020-01