Hormonal contraception and HIV: an unanswered question. Comment.

Most of the 16 million women currently living with HIV are in sub-Saharan Africa where 60% of HIV infections occur in women. A high proportion of women in this region also use hormonal contraception especially injectable depot-medroxyprogesterone acetate (DMPA). Since the first report of increased HIV acquisition in women taking oral contraceptives whether hormonal contraception increases the risk of HIV acquisition remains a crucial unanswered question. In The Lancet Infectious Diseases Renee Heffron and colleagues report from a study of nearly 3800 HIV-1 serodiscordant couples from seven African countries that women using hormonal contraception primarily DMPA had a two-times increased risk of acquiring HIV. Women who were HIV-infected at the beginning of the study and using injectable contraception were also twice as likely to transmit the infection to their uninfected male partners and had higher genital HIV RNA concentrations a potential mechanism for increased HIV transmission. This study adds to the growing body of observational evidence that DMPA might increase womens risk of acquiring and transmitting HIV. (Excerpt)