Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 May 20;2014(5):CD009741.
doi: 10.1002/14651858.CD009741.pub2.

Hormonal contraception for women exposed to HIV infection

G Justus Hofmeyr  1 , Mandisa Singata, Jennifer Sneden
Affiliations

Hormonal contraception for women exposed to HIV infection

G Justus Hofmeyr et al. Cochrane Database Syst Rev. .

Abstract

Background: Concern about a possible association of hormonal contraception with HIV acquisition has been raised by three types of evidence. Firstly, high-dose progestogen treatment greatly increases HIV acquisition in female non-human primates. Secondly, biological plausibility for a link between hormonal contraception anf HIV acquisition is provided by evidence of a hypo-oestrogenic state induced by progestogen contraception with vaginal mucosal thinning, and evidence of effects on the humoral and cellular immune systems. Thirdly, some but not other large observational studies have found an increase in HIV acquisition among women using hormonal contraception.

Objectives: To determine, from the best available evidence, the effect of hormonal contraception on HIV acquisition.

Search methods: We used the Cochrane Fertility Regulation Group trials search strategy.

Selection criteria: Published, unpublished and ongoing trials with random allocation, comparing hormonal with non-hormonal methods, other hormonal methods or no contraception in women at risk of HIV acquisition.

Data collection and analysis: Data will be extracted from eligible trials onto a data extraction sheet and analysed using routine Cochrane Collaboration methodology,

Main results: One ongoing randomised trial was identified, with no data available to date.

Authors' conclusions: There is currently no robust evidence from randomized trials on the possible effect of hormonal contraception on HIV acquisition. High quality trials in this area are needed to inform counselling of individual woman and public health policy.

PubMed Disclaimer

Conflict of interest statement

GJH and MS are conducting a randomised trial which may be considered for inclusion in the review (Hofmeyr 2006). They will not participate in any decisions regarding inclusion or interpretation of their study.

Update of

References

References to ongoing studies

Hofmeyr 2006 {unpublished data only}
    1. Expanding Contraceptive Health Options (ECHO) study. Ongoing study Protocol developed 2006; recruitment commenced 2009.

Additional references

Baeten 2007a
    1. Baeten JM, Benkic S, Chohane V, Lavreys L, McClelland RS, Mandaliya K, et al. Hormonal contraceptive use, herpes simplex virus infection, and risk of HIV‐1 acquisition among Kenyan women. AIDS 2007;21(13):1771‐7. - PubMed
Baeten 2007b
    1. Baeten JM, Lavreys L, Overbaugh J. The influence of hormonal contraceptive use on HIV‐1 transmission and disease progression. Clinical Infectious Diseases 2007; Vol. 45, issue 3:360–9. - PubMed
Blish 2011
    1. Blish CA, Baeten JM. Hormonal contraception and HIV transmission. American Journal of Reproductive Immunology 2011;65(3):302–7. - PMC - PubMed
Bright 2011
    1. Bright PL1, Norris Turner A, Morrison CS, Wong EL, Kwok C, Yacobson I, Royce RA, Tucker HO, Blumenthal PD. Hormonal contraception and area of cervical ectopy: a longitudinal assessment.. Contraception. 2011;84(5):512‐9. - PMC - PubMed
Bulterys 1994
    1. Bulterys M, Chao A, Habimana P, Dushimimana A, Nawrocki P, Saah A. Incident HIV‐1 infection in a cohort of young women in Butare, Rwanda. AIDS 1994;8(11):1585–91. - PubMed
CDC 2011
    1. Centers for Disease Control and Prevention Division for HIV/AIDS Prevention. Implementation of Routine HIV Testing in Health Care Settings: Issues for Community Health Centers. CDC Atlanta (accessed 2011).
Critchlow 1995
    1. Critchlow CW, Wöllner‐Hanson P, Eschenbach DA, Kiviat NB, Koutsky LA, Stevens CE, et al. Determinants of cervical ectopia and of cervicitis: age, oral contraception, specific cervical infection, smoking and douching. American Journal of Obstetrics and Gynecology 1995;173(2):534‐43. - PubMed
Curtis 2009
    1. Curtis KM, Nanda K, Kapp N. Safety of hormonal and intrauterine methods of contraception for women with HIV/AIDS: a systematic review.. AIDS 2009;Suppl 1:S55‐67. - PubMed
Egger 1997
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in metaanalysis detected by a simple, graphical test. BMJ 1997;315(7109):629‐34. - PMC - PubMed
Fleisher 1994
    1. Fleisher JM, Senie RT, Minkoff H, Jaccard J. Condom use relative to knowledge of sexually transmitted disease prevention, method of birth control, and past or present infection. Journal of Community Health 1994;19(6):395‐407. - PubMed
Harbord 2006
    1. Harbord RM, Egger M, Sterne JA. A modified test for small‐study effects in meta‐analysis of controlled trials with binary endpoints. Statistics in Medicine 2006;25:3443‐57. - PubMed
Heffron 2011
    1. Heffron R, Donnell D, Rees H, Celum C, Mugo N, Were E, et al. Use of hormonal contraceptives and risk of HIV‐1 transmission: a prospective cohort study. Lancet Infectious Diseases 2011;12(1):19‐26. - PMC - PubMed
Heffron 2012
    1. Heffron R, Donnell D, Rees H, Celum C, Mugo N, Were E, Bruyn G, Nakku‐Joloba E, Ngure K, Kiarie J, Coombs RW, Baeten JM, Partners in Prevention HSV/HIV Transmission Study Team. Use of hormonal contraceptives and risk of HIV‐1 transmission: a prospective cohort study.. Lancet Infect Dis. 2012;12(1):19‐26. - PMC - PubMed
Heikinheimo 2009
    1. Heikinheimo O, Lähteenmäki P. Contraception and HIV infection in women. Human Reproduction Update 2009;15(2):165–76. - PMC - PubMed
Hel 2010
    1. Hel Z, Stringer E, Mestecky J. Sex steroid hormones, hormonal contraception, and the immunobiology of human immunodeficiency virus‐1 infection. Endocr Rev 2010;31(1):79‐97. - PMC - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
Kapiga 1998
    1. Kapiga SH, Lyamuya EF, Lwihula GK, Hunter DJ. The incidence of HIV infection among women using family planning methods in Dar es Salaam, Tanzania. AIDS 1998;12(1):75–84. - PubMed
Kiddugavu 2003
    1. Kiddugavu M, Makumbi F, Wawer MJ, Serwadda D, Sewankambo NK, Wabwire‐Mangen F, et al. Hormonal contraceptive use and HIV‐1 infection in a population‐based cohort in Rakai, Uganda. AIDS 2003;17(2):233–40. - PubMed
Kilmarx 2000
    1. Kilmarx PH, Limpakarnjanarat K, Kaewkungwal J, Srismith R, Saisorn S, Uthaivoravit W, et al. Disease progression and survival with human immunodeficiency virus type 1 subtype E infection among female sex workers in Thailand. Infectious Disease 2000;181(5):1598–606. - PubMed
Kleinschmidt 2007
    1. Kleinschmidt I, Rees H, Delany S, Smith D, Dinat N, Nkala B, et al. Injectable progestin contraceptive use and risk of HIV infection in a South African family planning cohort. Contraception 2007;75(6):461–7. - PubMed
Kumwenda 2008
    1. Kumwenda JJ, Makanani B, Taulo F, Nkhoma C, Kafulafula G, Li Q, et al. Natural history and risk factors associated with early and established HIV type 1 infection among reproductive‐age women in Malawi. Clinical Infectious Diseases 2008;46(12):1913–20. - PubMed
Lavreys 2004
    1. Lavreys L, Baeten JM, Martin HL Jr, Overbaugh J, Mandaliya K, Ndinya‐Achola J, et al. Hormonal contraception and risk of HIV‐1 acquisition: results of a 10‐year prospective study. AIDS 2004;18(4):695‐7. - PubMed
Lawrie 1998
    1. Lawrie TA, Hofmeyr GJ, Jager M, Berk M, Paiker J, Viljoen E. A double‐blind randomised placebo controlled trial of postnatal norethisterone enanthate: the effect on postnatal depression and serum hormones. British Journal of Obstetrics and Gynaecology 1998;105(10):1082‐90. - PubMed
Martin 1999
    1. Martin HL, Richardson BA, Nyange PM, Lavreys L, Hillier SL, Chohan B, et al. Vaginal lactobacilli, microbial flora, and risk of human immunodeficiency virus type 1 and sexually transmitted disease acquisition. Infectious Disease 1999;180(6):1863–8. - PubMed
Marx 1996
    1. Marx PA, Spira AI, Gettie A, Dailey PJ, Veazey RS, Lackner AA, et al. Progesterone implants enhance SIV vaginal transmission and early virus load. Nature Medicine 1996;2(10):1084–9. - PubMed
Mauck 1999
    1. Mauck CK, Callahan MM, Baker J, Arbogast K, Veazey R, Stock R, et al. The effect of one injection of Depo‐Provera on the human vaginal epithelium and cervical ectopy. Contraception 1999;60(1):15–24. - PubMed
Mensch 2011
    1. Mensch B, Hewett PC, Abbott S, Rankin J, Littlefield S, Ahmed K, et al. Assessing the reporting of adherence and sexual activity in a simulated microbicide trial in South Africa: an interview mode experiment using a placebo gel. AIDS Behavior 2011;15(2):407–21. - PubMed
Miller 2000
    1. Miller L, Patton DL, Meier A, Thwin SS, Hooton TM, Eschenbach DA. Depomedroxyprogesterone‐induced hypoestrogenism and changes in vaginal flora and epithelium. Obstetrics and Gynecology 2000;96(3):431–9. - PubMed
Morrison 2009
    1. Morrison CS, Turner AN, Jones LSB. Highly effective contraception and acquisition of HIV and other sexually transmitted infections. Best Practice & Research. Clinical Obstetrics & Gynaecology 2009;23(2):263‐84. - PubMed
Morrison 2010
    1. Morrison CS, Chen PL, Kwok C, Richardson BA, Chipato T, Mugerwa R, Byamugisha J, Padian N, Celentano DD, Salata RA. Hormonal contraception and HIV acquisition: reanalysis using marginal structural modeling.. AIDS. X 2010;24(11):1778‐81. - PMC - PubMed
Morrison 2011
    1. Morrison CS, Chen PL, Nankya I, Rinaldi A, Pol B, Ma YR, et al. Hormonal contraceptive use and HIV disease progression among women in Uganda and Zimbabwe. Journal of Acquired Immune Deficiency Syndromes 2011;57(2):157. - PMC - PubMed
Moss 1991
    1. Moss G, Clementson D, D’Costa I, Plummer F, Ndinya‐Achola J, Reilly M, et al. Associations of cervical ectopy with heterosexual transmission of human immunodeficiency virus: results from a study of couples in Nairobi, Kenya. Infectious Disease 1991;164(3):588‐91 . - PubMed
Polis 2013
    1. Polis CB, Curtis KM. Use of hormonal contraceptives and HIV acquisition inwomen: a systematic review of the epidemiologicalevidence. Lancet Infect Dis. 2013;13(9):797‐808. - PubMed
RevMan 2011 [Computer program]
    1. The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). Version 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
Shulman 2011
    1. Shulman LP. The state of hormonal contraception today: benefits and risks of hormonal contraceptives: combined estrogen and progestin contraceptives. American Journal of Obstetrics and Gynecology. 2011;205(Suppl 4):S9–13. - PubMed
Smith 2004
    1. Smith SM, Mefford M, Sodora D, Klase Z, Singh M, Alexander N, et al. Topical estrogen protects against SIV vaginal transmission without evidence of systemic effect. AIDS 2004;18(12):1637–43. - PubMed
Stringer 2010
    1. Stringer E, Hel Z, Mestecky J. Sex steroid hormones, hormonal contraception, and the immunobiology of human immunodeficiency virus‐1 infection. Endocrine Reviews 2010;31(1):79‐97. - PMC - PubMed
UN 2010
    1. United Nations & Department of Economic and Social Affairs, Population Division. World Contraceptive Use 2010 Chart. UN Report 2010.
UNAIDS 2010
    1. UNAIDS, WHO Regional Office Europe. Global Report UNAIDS on the Global Aids Epidemic 2010. UNAIDS Epidemic Update Report 2010:65‐70.
Urdl 2005
    1. Urdl W, Apter D, Alperstein A, Koll P, Schönian S, Bringer J, et al. ORTHO EVRA/EVRA 003 Study Group. Contraceptive efficacy, compliance and beyond: factors related to satisfaction with once‐weekly transdermal compared with oral contraception. European Journal of Obstetrics & Gynecology and Reproductive Biology 2005;121(2):202‐10. - PubMed
Wang 1999
    1. Wang CC, Reilly M, Kreiss JK. Risk of HIV infection in oral contraceptive pill users: a meta‐analysis. Journal of Acquired Immune Deficiency Syndromes 1999;21(1):51–8. - PubMed
Wawer 2012
    1. Wawer MJ, Gray RH. Challenges in assessing associations between hormonal contraceptive use and the risks of HIV‐1 acquisition and transmission.. Future Microbiol 2012;7(3):315‐318. - PubMed
WHO 2010
    1. World Health Organization and the Department of Sexual and Reproductive Health. Medical eligibility criteria for contraceptive use: Fourth Edition. WHO Report 2010.
WHO 2012a
    1. WHO. Technical statement "Hormonal contraception and HIV". http://www.who.int/reproductivehealth/publications/family_planning/rhr_12_8. - PubMed
WHO 2012b
    1. WHO. Programmatic and research considerations for hormonal contraception for women at risk of HIV and women living with HIV. http://www.who.int/reproductivehealth/topics/family_planning/hc_hiv/en/i....

Publication types

MeSH terms

LinkOut - more resources