Hormonal contraception and HIV disease progression

Abstract

The majority of the 15.4 million human immunodeficiency virus (HIV)-infected women worldwide are of child-bearing age and need access to contraception. Hormonal methods of contraception are safe, acceptable, and effective in preventing unwanted pregnancies. Many published studies have examined the impact of hormonal contraception on HIV disease acquisition and transmissibility. Far fewer have investigated the relationship between hormonal contraception and HIV disease progression. This review examines available data on this relationship from clinical, animal, and immunological studies. Several clinical studies suggest an overall effect but are not definitive, and the mechanisms behind HIV disease progression are unclear. Animal and immunological data suggest that immunomodulation by hormonal contraceptive methods may affect the immune response to HIV infection. Additional work is needed in this area to elucidate the possible relationship between hormonal methods for birth control and progression to acquired immunodeficiency syndrome in HIV-infected women.

Figure 1

Potential effects of hormonal contraception on the pathogenesis of HIV infection. Arrows pointing down indicate decreases in immune response, arrows pointing up indicate increases in immune response, and question marks indicate unknown effects. The boxed sections denote processes in which hormonal effects may be significant. E, estrogens (effects of E on immune responses are shown in blue); IDO, indolamine 2,3-deoxygenase; P, progesterone (effects of P on immune response are shown in red).