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Public Library of Science, PLoS Medicine, 1(12), p. e1001778, 2015

DOI: 10.1371/journal.pmed.1001778

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Hormonal Contraception and the Risk of HIV Acquisition: An Individual Participant Data Meta-analysis

Journal article published in 2015 by Charles S. Morrison, L. van Damme, Pai-Lien Chen, Cynthia Kwok, Jared M. Baeten, Joelle Brown, Angela M. Crook, Lut-U.-T. Van Damme, Van Lut, Sinead Delany-Moretlwe, Damme, Suzanna C. Francis ORCID, Barbara A. Friedland, Richard J. Hayes, Renee Heffron and other authors.
This paper is made freely available by the publisher.
This paper is made freely available by the publisher.

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Abstract

Observational studies of a putative association between hormonal contraception (HC) and HIV acquisition have produced conflicting results. We conducted an individual participant data (IPD) meta-analysis of studies from sub-Saharan Africa to compare the incidence of HIV infection in women using combined oral contraceptives (COCs) or the injectable progestins depot-medroxyprogesterone acetate (DMPA) or norethisterone enanthate (NET-EN) with women not using HC.Eligible studies measured HC exposure and incident HIV infection prospectively using standardized measures, enrolled women aged 15-49 y, recorded ≥15 incident HIV infections, and measured prespecified covariates. Our primary analysis estimated the adjusted hazard ratio (aHR) using two-stage random effects meta-analysis, controlling for region, marital status, age, number of sex partners, and condom use. We included 18 studies, including 37,124 women (43,613 woman-years) and 1,830 incident HIV infections. Relative to no HC use, the aHR for HIV acquisition was 1.50 (95% CI 1.24-1.83) for DMPA use, 1.24 (95% CI 0.84-1.82) for NET-EN use, and 1.03 (95% CI 0.88-1.20) for COC use. Between-study heterogeneity was mild (I(2)