An updated systematic review of epidemiological evidence on hormonal contraceptive methods and HIV acquisition in women.
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OBJECTIVE AND DESIGN: Some studies suggest that specific hormonal contraceptive methods [particularly depot medroxyprogesterone acetate (DMPA)] may increase women's HIV acquisition risk. We updated a systematic review to incorporate recent epidemiological data. METHODS: We searched for articles published between 15 January 2014 and 15 January 2016 and hand-searched reference lists. We identified longitudinal studies comparing users of a specific hormonal contraceptive method against either nonusers of hormonal contraception or users of another specific hormonal contraceptive method. We added newly identified studies to those in the previous review, assessed study quality, created forest plots to display results, and conducted a meta-analysis for data on DMPA versus non-use of hormonal contraception. RESULTS: We identified 10 new reports of which five were considered 'unlikely to inform the primary question'. We focus on the other five reports, along with nine from the previous review, which were considered 'informative but with important limitations'. The preponderance of data for oral contraceptive pills, injectable norethisterone enanthate, and levonorgestrel implants do not suggest an association with HIV acquisition, though data for implants are limited. The new, higher quality studies on DMPA (or nondisaggregated injectables), which had mixed results in terms of statistical significance, had hazard ratios between 1.2 and 1.7, consistent with our meta-analytic estimate for all higher quality studies of hazard ratio 1.4. CONCLUSION: Although confounding in these observational data cannot be excluded, new information increases concerns about DMPA and HIV acquisition risk in women. If the association is causal, the magnitude of effect is likely hazard ratio 1.5 or less. Data for other hormonal contraceptive methods, including norethisterone enanthate, are largely reassuring.
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A systematic review of epidemiologic evidence reported that the majority of studies demonstrated no association between use of oral contraceptives and HIV acquisition among women.
“A systematic review of epidemiologic evidence reported that the majority of studies demonstrated no association between use of oral contraceptives and HIV acquisition among women (55).”
From Sexually Transmitted Infections Treatment Guidelines, 2021 (2021) · cites this paper as [55]
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Smith, J., Heffron, R. A., Butler, A. R., Celum, C., Baeten, J. M., & Hallett, T. B. (2016) · Contraception · doi:10.1016/j.contraception.2016.12.003 · Cited by 12 · see citing works
Tasker, C., Davidow, A. L., Roche, N., & Chang, T. L.-Y. (2017) · ImmunoHorizons · doi:10.4049/immunohorizons.1700047 · Cited by 12 · see citing works
Calla, N. E. Q., Miguel, R. D. V., Torres, A. R., Trout, W., Gabriel, J., Hatfield, A. M., Aceves, K. M., Kwiek, J. J., Kaur, B., & Cherpes, T. L. (2020) · ImmunoHorizons · doi:10.4049/immunohorizons.1900077 · Cited by 12 · see citing works
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Copper intrauterine device use and HIV acquisition in women: a systematic review
Hannaford, P. C., Ti, A. J., Chipato, T., & Curtis, K. M. (2020) · BMJ Sexual & Reproductive Health · doi:10.1136/bmjsrh-2019-200512 · Cited by 11 · see citing works
Self-citation
- Authors
- Polis, C. B., Curtis, K. M., Hannaford, P. C., Phillips, S. J., Chipato, T., Kiarie, J. N., Westreich, D. J., & Steyn, P. S.
- Affiliations
- Boston University (US)
- Corresponding author
- Polis, Chelsea B.
- ORCID
- Venue
- AIDS
- Published
- 2016-11-13
- Volume
- 30
- Issue
- 17
- Pages
- 2665-2683
- ISSN
- 0269-9370 (ISSN-L)
- PMC
- PMC5106090
- OpenAlex
- W2544080039
- Cited by
- 196
- References
- 75
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 6 · 2023: 9 · 2022: 11 · 2021: 16 · 2020: 31 · 2019: 39 · 2018: 37 · 2017: 21 · 2016: 8 · 2015: 8 · 2014: 1
- FWCI
- 5.38
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- AIDS (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Aberdeen University Research Archive (Aberdeen University) (submittedVersion)
- Funders
- World Health Organization
- National Institutes of Health (NIH DP2, DP2‐HD‐08‐4070, 1dp2hd084070-01)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R24HD074034, DP2-HD-08-4070)
- Topics
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Keywords
- hormonal contraception, HIV acquisition, women, depot medroxyprogesterone acetate, injectable contraceptives, oral contraceptives, norethisterone enanthate, levonorgestrel implants, HIV risk, confounding
- MeSH terms
- Contraception, Contraceptive Agents, Female, Female, Humans, HIV Infections, Risk Assessment
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