Update on the Impact of Depot Medroxyprogesterone Acetate on Vaginal Mucosal Endpoints and Relevance to Sexually Transmitted Infections

Smritee Dabee¹, Christina Balle^{2

3}, Maricianah Onono⁴, Steve Innes⁵, Gonasagrie Nair⁵, Thesla Palanee-Phillips⁶, Adam D Burgener^{7

8

9}, Steven E Bosinger^{10

11

12}, Jo-Ann S Passmore^{2

13}, Renee Heffron^{14

15}, Heather Jaspan^{16

17

18

19

20}, Anna-Ursula Happel^{2

3}

Affiliations

¹ Center for Global Infectious Disease, Seattle Children's Research Institute, 307 Westlake Ave. N, Seattle, WA, 98109, USA.
² Department of Pathology, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa.
³ Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa.
⁴ Kenya Medical Research Institute, Busia Rd, Kisumu, Kenya.
⁵ Desmond Tutu Health Foundation, 3 Woodlands Rd, Woodstock, Cape Town, 7915, South Africa.
⁶ Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Klein St & Esselen St, Hillbrow, Johannesburg, 2001, South Africa.
⁷ Center for Global Health and Diseases, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH, 44106, USA.
⁸ Department of Obstetrics and Gynecology, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, R3T 2N2, Canada.
⁹ Unit of Infectious Diseases, Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institute, Karolinska University Hospital, Visionsgatan 18, L8, 171 76, Solna, Sweden.
¹⁰ ENPRC Genomics Core Laboratory, Emory National Primate Research Center, 954 Gatewood Rd NE, Atlanta, GA, 30329, USA.
¹¹ Department of Pathology and Laboratory Medicine, Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA, 30307, USA.
¹² Emory Vaccine Center, Emory University, 7 1st Ave, Atlanta, GA, 30317, USA.
¹³ National Health Laboratory Service, Anzio Road, Observatory, Cape Town, 7925, South Africa.
¹⁴ Department of Medicine, University of Alabama at Birmingham, 845 19th Street South, AL, 35294-2170, Birmingham, USA.
¹⁵ Department of Global Health, University of Washington, 1510 San Juan Road NE, Seattle, WA, 98195, USA.
¹⁶ Center for Global Infectious Disease, Seattle Children's Research Institute, 307 Westlake Ave. N, Seattle, WA, 98109, USA. hbjaspan@gmail.com.
¹⁷ Department of Pathology, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa. hbjaspan@gmail.com.
¹⁸ Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa. hbjaspan@gmail.com.
¹⁹ Department of Pediatrics, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA. hbjaspan@gmail.com.
²⁰ Department of Global Health, University of Washington, 1510 San Juan Road NE, Seattle, WA, 98195, USA. hbjaspan@gmail.com.

PMID: 37341916
PMCID: PMC10403392
DOI: 10.1007/s11904-023-00662-0

Review

Update on the Impact of Depot Medroxyprogesterone Acetate on Vaginal Mucosal Endpoints and Relevance to Sexually Transmitted Infections

Smritee Dabee et al. Curr HIV/AIDS Rep. 2023 Aug.

. 2023 Aug;20(4):251-260.

doi: 10.1007/s11904-023-00662-0. Epub 2023 Jun 21.

Authors

Affiliations

¹ Center for Global Infectious Disease, Seattle Children's Research Institute, 307 Westlake Ave. N, Seattle, WA, 98109, USA.
² Department of Pathology, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa.
³ Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa.
⁴ Kenya Medical Research Institute, Busia Rd, Kisumu, Kenya.
⁵ Desmond Tutu Health Foundation, 3 Woodlands Rd, Woodstock, Cape Town, 7915, South Africa.
⁶ Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Klein St & Esselen St, Hillbrow, Johannesburg, 2001, South Africa.
⁷ Center for Global Health and Diseases, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH, 44106, USA.
⁸ Department of Obstetrics and Gynecology, University of Manitoba, 66 Chancellors Cir, Winnipeg, MB, R3T 2N2, Canada.
⁹ Unit of Infectious Diseases, Department of Medicine Solna, Center for Molecular Medicine, Karolinska Institute, Karolinska University Hospital, Visionsgatan 18, L8, 171 76, Solna, Sweden.
¹⁰ ENPRC Genomics Core Laboratory, Emory National Primate Research Center, 954 Gatewood Rd NE, Atlanta, GA, 30329, USA.
¹¹ Department of Pathology and Laboratory Medicine, Emory University School of Medicine, 2015 Uppergate Dr, Atlanta, GA, 30307, USA.
¹² Emory Vaccine Center, Emory University, 7 1st Ave, Atlanta, GA, 30317, USA.
¹³ National Health Laboratory Service, Anzio Road, Observatory, Cape Town, 7925, South Africa.
¹⁴ Department of Medicine, University of Alabama at Birmingham, 845 19th Street South, AL, 35294-2170, Birmingham, USA.
¹⁵ Department of Global Health, University of Washington, 1510 San Juan Road NE, Seattle, WA, 98195, USA.
¹⁶ Center for Global Infectious Disease, Seattle Children's Research Institute, 307 Westlake Ave. N, Seattle, WA, 98109, USA. hbjaspan@gmail.com.
¹⁷ Department of Pathology, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa. hbjaspan@gmail.com.
¹⁸ Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa. hbjaspan@gmail.com.
¹⁹ Department of Pediatrics, University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA. hbjaspan@gmail.com.
²⁰ Department of Global Health, University of Washington, 1510 San Juan Road NE, Seattle, WA, 98195, USA. hbjaspan@gmail.com.

PMID: 37341916
PMCID: PMC10403392
DOI: 10.1007/s11904-023-00662-0

Abstract

Purpose of review: The long-acting reversible intramuscularly-injected contraceptive depot medroxyprogesterone acetate (DMPA-IM) is widely used by cisgender women in Africa. Although DMPA-IM provides reliable contraception, potential effects on the female genital tract (FGT) mucosa have raised concern, including risk of HIV infection. This review summarises and compares evidence from observational cohort studies and the randomised Evidence for Contraceptive Options in HIV Outcomes (ECHO) Trial.

Recent findings: Although previous observational studies found women using DMPA-IM had higher abundance of bacterial vaginosis (BV)-associated bacteria, increased inflammation, increased cervicovaginal HIV target cell density, and epithelial barrier damage, sub-studies of the ECHO Trial found no adverse changes in vaginal microbiome, inflammation, proteome, transcriptome, and risk of viral and bacterial STIs, other than an increase in Th17-like cells. Randomised data suggest that DMPA-IM use does not adversely change mucosal endpoints associated with acquisition of infections. These findings support the safe use of DMPA-IM in women at high risk of acquiring STIs, including HIV.

Keywords: Depot medroxyprogesterone acetate; ECHO Trial; Epithelial barrier; Immune cells; Inflammation; Vaginal microbiome.

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Conflict of interest statement

The authors declare no competing interests.

References

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Update on the Impact of Depot Medroxyprogesterone Acetate on Vaginal Mucosal Endpoints and Relevance to Sexually Transmitted Infections

Affiliations

Update on the Impact of Depot Medroxyprogesterone Acetate on Vaginal Mucosal Endpoints and Relevance to Sexually Transmitted Infections

Authors

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Conflict of interest statement

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