Hormonal Agent Review Sees Mixed Signals on HIV Transmission Risk
A systematic review of studies addressing the question of female-to-male HIV transmission risk with hormonal contraceptives did not reach a definitive conclusion, a result underling the need for more study.
One observational study in African women and men yielded evidence that hormonal contraception is associated with an increased risk of HIV transmission from women to men (Heffron R, et al. Lancet Infectious Diseases. 2012; 12: 19-26, linked below). To shed more light on this issue, researchers conducted this systematic review of hormonal contraception and HIV studies published or in press through 15 December 2011.
The analysis included studies with direct evidence on hormonal contraception use and HIV transmission and studies with indirect evidence related to genital or plasma viral load. Only the study mentioned above (Heffron et al.) had direct evidence. That analysis found a significantly increased risk of female-to-male transmission with injectable hormonal contraceptives (adjusted hazard ratio 1.95, 95% confidence interval [CI] 1.06 to 3.58) and a nonsignificant increase with oral hormonal contraceptives (adjusted hazard ratio 2.09, 95% CI 0.75 to 5.84).
Findings from 11 studies indirectly assessed the impact of hormonal contraception on viral genital shedding or viral load set point. These studies produced mixed findings. Seven of eight studies found no adverse effect of various hormonal contraception methods on plasma viral load, a result suggesting that hormonal contraception would not heighten the risk of HIV transmission.
“Given the potential for confounding in observational data, the paucity of direct evidence on this subject, and mixed indirect evidence,” the authors conclude, “additional evidence is needed.”
Reviewing much of this same evidence, the World Health Organization issued a technical statement in February 2012 asserting that available data are “not sufficiently conclusive to change current guidance” recommending hormonal contraception for HIV-positive women and stressing the need for “consistent and correct use of condoms, male or female, . . . for prevention of HIV transmission to non-infected sexual partners.”
Source: Chelsea B. Polis, Sharon J. Phillips, Kathryn M. Curtis. Hormonal contraceptive use and female-to-male HIV transmission: a systematic review of the epidemiologic evidence. AIDS. 2013; 27: 493-505.
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For the WHO technical statement
Written by Mark Mascolini on behalf of the International AIDS Society