An article published online first in The Lancet Infectious Diseases reveals that according to a study conducted on almost 3,800 couples, women's risk of acquiring HIV-1 and transmitting the virus to their male partner is doubled if they use hormonal contraception, especially in those using injectable contraception methods.

Researcher Jared Baeten from the University of Washington, Seattle, USA said:

"These findings have important implications for family planning and HIV-1 prevention programs, especially in settings with high HIV-1 prevalence."

His colleague, lead author Renee Heffron emphasized:

"Recommendations regarding contraceptive use, particularly emphasizing the importance of dual protection with condoms and the use of non-hormonal and low-dose hormonal methods for women with or at risk for HIV-1, are urgently needed."

Hormonal contraception either in form of a daily oral pill or long-acting injections is used by over 140 million women worldwide, including approximately 16 million HIV-infected women living in sub-Saharan Africa. Earlier studies produced inconsistent results when examining whether hormonal contraceptives might change women's risk of becoming infected with HIV.

Heffron and his team wanted to assess whether the risk of acquiring HIV and transmitting the virus to their male partners was increased in women using hormonal contraception. They conducted two longitudinal studies of HIV-1 incidence in seven African countries in which they evaluated 3,790 heterosexual HIV-1 serodiscordant couples, i.e. one partner without HIV-1 infection and the other partner being infected. The African countries included Botswana, Rwanda, Kenya, Uganda, South Africa, Tanzania and Zimbabwe.

According to the results, women using hormonal contraceptives were twice as likely to become infected with HIV-1, with the risk increasing for both injectable contraceptives, i.e. mainly depot medroxprogeterone acetate: DMPA. The risk for oral contraceptives did not significantly increase statistically.

Researchers also discovered that in comparison to women who did not use hormonal contraception, those who were HIV-positive at the beginning of the study using injectable contraception had a two-times higher risk of transmitting the virus to their male partner.

According to the authors:

"To our knowledge, ours is the first prospective study to show increased HIV-1 risk in male partners of HIV-1 infected women using hormonal contraception."

They concluded writing:

"Data on HIV-1 risk associated with...other hormonal contraceptives, such as implants, patches, or combined injectables...and non-hormonal contraceptive methods such as intrauterine devices, are urgently needed, and strategies to improve accessibility and uptake of these lower-dose and non-hormonal methods should be prioritized. Contraceptive counseling should be combined with HIV-1 counseling and testing."

Charles S Morrison from Clinical Sciences, Durham, USA added in a comment:

"Active promotion of DMPA in areas with high HIV incidence could be contributing to the HIV epidemic in sub-Saharan Africa, which would be tragic. Conversely, limiting one of the most highly used effective methods of contraception in sub-Saharan Africa would probably contribute to increased maternal mortality and morbidity and more low birth-weight babies and orphans - an equally tragic result. The time to provide a more definitive answer to this critical public health question is now; the donor community should support a randomized trial of hormonal contraception and HIV acquisition."

Written by Petra Rattue