October 4, 2011

Hormonal contraception use doubles HIV risk, according to UW study in Lancet

UW Health Sciences/UW Medicine

A UW-led study published in The Lancet Infectious Diseases shows a troubling link between hormonal contraception and HIV. The study is getting widespread press coverage because of the popularity of injectable birth control like Depo-Provera in parts of Africa hardest hit by the AIDS epidemic.

The observational study of nearly 3,800 couples in Africa finds that women using hormonal contraception –such as a birth control pill or a shot like Depo-Provera – are at double the risk of acquiring HIV. Moreover, HIV-infected women who use hormonal contraception have twice the risk of transmitting the virus to their HIV-uninfected male partners.

Major news outlets– BBC, NPR, The New York Times, CBS, NBC, Humanosphere, L.A. Times, The Guardian, Voice of America, and others – are reporting on the findings.

Lead study author Renee Heffron, an epidemiology doctoral student working with the International Clinical Research Center at UW, said the research emphasizes the need for couples to use condoms in addition to other forms of contraception to prevent pregnancy and HIV.

“Women should be counseled about potentially increased risk of HIV acquisition and transmission with hormonal contraception, particularly injectable methods, and about the importance of dual protection with condoms to decrease HIV risk,” said Heffron.

Jared Baeten, an associate professor of global health with the International Clinical Research Center, said to his knowledge this is the first prospective study to show increased HIV risk to male partners of HIV-infected women who use hormonal contraception.

More than 140 million women worldwide use hormonal contraception, including daily oral pills and long-acting injectables, like Depo-Provera, according to the researchers.

The New York Times reported that a hormone shot given every three months is the most popular contraceptive for women in eastern and southern Africa, and said  the “findings potentially present an alarming quandary for women in Africa.”

Isobel Coleman, director of the women and foreign policy program at the Council on Foreign Relations, told The New York Times:

“The best contraception today is injectable hormonal contraception because you dont need a doctor, its long-lasting, it enables women to control timing and spacing of birth without a lot of fuss and travel…If it is now proven that these contraceptions are helping spread the AIDS epidemic, we have a major health crisis on our hands.”

While the study involved only women in Africa, The New York Times noted the biological effects would probably be the same for all women.  However, the concern is greatest in Africa because the risk of HIV from heterosexual sex is so much higher than elsewhere.

The study included 3,790 heterosexual HIV serodiscordant couples (that is, one partner with HIV infection and the other without) who were participating in two long-term studies of HIV in couples in seven African countries: Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda and Zimbabwe.

The work was funded with support from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute of Allergy and Infectious Diseases, the UW STD/AIDS Research Training Grant Program and the Bill & Melinda Gates Foundation.

The International Clinical Research Center, part of the UW Department of Global Health, is conducting multiple clinical trials in Africa related to the prevention of HIV and is expanding the UW’s capacity to conduct pre-eminent biomedical prevention and research in infectious disease prevention.