Cited by 196HIV/AIDS Research and InterventionsReproductive Health and ContraceptionCervical Cancer and HPV Research

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An updated systematic review of epidemiological evidence on hormonal contraceptive methods and HIV acquisition in women.

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Polis, Chelsea B., Curtis, Kathryn M., Hannaford, Philip C., Phillips, Sharon J., Chipato, Tsungai, Kiarie, James N., Westreich, Daniel J., Steyn, Petrus S.·2016·AIDS

DOI 10.1097/qad.0000000000001228PMC PMC5106090

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Abstract

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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Fig. 1 Identification of newly included studies.CC BY · PubMed Central

Fig. 2 Use of oral contraceptives (versus non-use of hormonal contraception) and HIV acquisition, among 11 studies considered informative but with important limitations.CC BY · PubMed Central

Fig. 3 Use of injectables (depot medroxyprogesterone acetate, norethisterone enanthate, or unspecified injectable) versus non-use of hormonal contraception and HIV acquisition, among 12 studies considered informative but with important limitations.CC BY · PubMed Central

Fig. 4 Use of depot medroxyprogesterone acetate (or unspecified injectable) versus non-use of hormonal contraception and HIV acquisition, among 12 studies considered informative but with important limitations.CC BY · PubMed Central

Fig. 5 Use of norethisterone enanthate versus non-use of hormonal contraception and HIV acquisition, among six studies considered informative but with important limitations.CC BY · PubMed Central

Fig. 6 Hormonal contraceptive methods and HIV acquisition in head-to-head studies, among two studies considered informative but with important limitations.CC BY · PubMed Central

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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: Polis, Chelsea B.
Curtis, Kathryn M.
Hannaford, Philip C.
Phillips, Sharon J.
Chipato, Tsungai
Kiarie, James N.
Westreich, Daniel J.
Steyn, Petrus S.
Venue: AIDS
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2016-11-13
Volume: 30
Issue: 17
Pages: 2665-2683
ISSN: 0269-9370 (ISSN-L)
DOI: 10.1097/qad.0000000000001228
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
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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An updated systematic review of epidemiological evidence on hormonal contraceptive methods and HIV acquisition in women.

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