Tags

Type your tag names separated by a space and hit enter

Risk of HIV-1 acquisition among women who use diff erent types of injectable progestin contraception in South Africa: a prospective cohort study.
Lancet HIV 2015; 2(7):e279-87LH

Abstract

BACKGROUND

Several observational studies have reported that HIV-1 acquisition seems to be higher in women who use depot medroxyprogesterone acetate (DMPA) than in those who do not use hormonal contraception. We aimed to assess whether two injectable progestin-only contraceptives, DMPA and norethisterone enanthate (NET-EN), confer different risks of HIV-1 acquisition.

METHODS

We included data from South African women who used injectable contraception while participating in theVOICE study, a multisite, randomised, placebo-controlled trial that investigated the safety and efficacy of three formulations of tenofovir for prevention of HIV-1 infection in women between Sept 9, 2009, and Aug 13, 2012. Women were assessed monthly for contraceptive use and incident infection. We estimated the difference in incident HIV-1infection between DMPA and NET-EN users by Cox proportional hazards regression analyses in this prospective cohort. The VOICE trial is registered with ClinicalTrials.gov, NCT00705679.

FINDINGS

3141 South African women using injectable contraception were included in the present analysis: 1788 (56·9%)solely used DMPA, 1097 (34·9%) solely used NET-EN, and 256 (8·2%) used both injectable types at different times during follow-up. During 2733·7 person-years of follow-up, 207 incident HIV-1 infections occurred (incidence7·57 per 100 person-years, 95% CI 6·61–8·68). Risk of HIV-1 acquisition was higher among DMPA users (incidence 8·62 per 100 person-years, 95% CI 7·35–10·11) than among NET-EN users (5·67 per 100 person-years, 4·35–7·38;hazard ratio 1·53, 95% CI 1·12–2·08; p=0·007). This association persisted when adjusted for potential confoundingvariables (adjusted hazard ratio [aHR] 1·41, 95% CI 1·06–1·89; p=0·02). Among women seropositive for herpes simplex virus type 2 (HSV-2) at enrolment, the aHR was 2·02 (95% CI 1·26–3·24) compared with 1·09 (0·78–1·52)for HSV-2-seronegative women (pinteraction=0·07).

INTERPRETATION

Although moderate associations in observational analyses should be interpreted with caution, thesefi ndings suggest that NET-EN might be an alternative injectable drug with a lower HIV risk than DMPA in high HIV-1 incidence settings where NET-EN is available.

FUNDING

National Institutes of Health, Mary Meyer Scholars Fund, and the Ruth Freeman Memorial Fund.

Authors

No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26155597

Citation

Noguchi, Lisa M., et al. "Risk of HIV-1 Acquisition Among Women Who Use Diff Erent Types of Injectable Progestin Contraception in South Africa: a Prospective Cohort Study." The Lancet. HIV, vol. 2, no. 7, 2015, pp. e279-87.
Noguchi LM, Richardson BA, Baeten JM, et al. Risk of HIV-1 acquisition among women who use diff erent types of injectable progestin contraception in South Africa: a prospective cohort study. Lancet HIV. 2015;2(7):e279-87.
Noguchi, L. M., Richardson, B. A., Baeten, J. M., Hillier, S. L., Balkus, J. E., Chirenje, Z. M., ... Marrazzo, J. M. (2015). Risk of HIV-1 acquisition among women who use diff erent types of injectable progestin contraception in South Africa: a prospective cohort study. The Lancet. HIV, 2(7), pp. e279-87.
Noguchi LM, et al. Risk of HIV-1 Acquisition Among Women Who Use Diff Erent Types of Injectable Progestin Contraception in South Africa: a Prospective Cohort Study. Lancet HIV. 2015;2(7):e279-87. PubMed PMID: 26155597.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Risk of HIV-1 acquisition among women who use diff erent types of injectable progestin contraception in South Africa: a prospective cohort study. AU - Noguchi,Lisa M, AU - Richardson,Barbra A, AU - Baeten,Jared M, AU - Hillier,Sharon L, AU - Balkus,Jennifer E, AU - Chirenje,Z Mike, AU - Bunge,Katherine, AU - Ramjee,Gita, AU - Nair,Gonasagrie, AU - Palanee-Phillips,Thesla, AU - Selepe,Pearl, AU - van der Straten,Ariane, AU - Parikh,Urvi M, AU - Gomez,Kailazarid, AU - Piper,Jeanna M, AU - Watts,D Heather, AU - Marrazzo,Jeanne M, AU - ,, PY - 2015/7/9/entrez PY - 2015/7/15/pubmed PY - 2016/8/9/medline SP - e279 EP - 87 JF - The lancet. HIV JO - Lancet HIV VL - 2 IS - 7 N2 - BACKGROUND: Several observational studies have reported that HIV-1 acquisition seems to be higher in women who use depot medroxyprogesterone acetate (DMPA) than in those who do not use hormonal contraception. We aimed to assess whether two injectable progestin-only contraceptives, DMPA and norethisterone enanthate (NET-EN), confer different risks of HIV-1 acquisition. METHODS: We included data from South African women who used injectable contraception while participating in theVOICE study, a multisite, randomised, placebo-controlled trial that investigated the safety and efficacy of three formulations of tenofovir for prevention of HIV-1 infection in women between Sept 9, 2009, and Aug 13, 2012. Women were assessed monthly for contraceptive use and incident infection. We estimated the difference in incident HIV-1infection between DMPA and NET-EN users by Cox proportional hazards regression analyses in this prospective cohort. The VOICE trial is registered with ClinicalTrials.gov, NCT00705679. FINDINGS: 3141 South African women using injectable contraception were included in the present analysis: 1788 (56·9%)solely used DMPA, 1097 (34·9%) solely used NET-EN, and 256 (8·2%) used both injectable types at different times during follow-up. During 2733·7 person-years of follow-up, 207 incident HIV-1 infections occurred (incidence7·57 per 100 person-years, 95% CI 6·61–8·68). Risk of HIV-1 acquisition was higher among DMPA users (incidence 8·62 per 100 person-years, 95% CI 7·35–10·11) than among NET-EN users (5·67 per 100 person-years, 4·35–7·38;hazard ratio 1·53, 95% CI 1·12–2·08; p=0·007). This association persisted when adjusted for potential confoundingvariables (adjusted hazard ratio [aHR] 1·41, 95% CI 1·06–1·89; p=0·02). Among women seropositive for herpes simplex virus type 2 (HSV-2) at enrolment, the aHR was 2·02 (95% CI 1·26–3·24) compared with 1·09 (0·78–1·52)for HSV-2-seronegative women (pinteraction=0·07). INTERPRETATION: Although moderate associations in observational analyses should be interpreted with caution, thesefi ndings suggest that NET-EN might be an alternative injectable drug with a lower HIV risk than DMPA in high HIV-1 incidence settings where NET-EN is available. FUNDING: National Institutes of Health, Mary Meyer Scholars Fund, and the Ruth Freeman Memorial Fund. SN - 2352-3018 UR - https://www.unboundmedicine.com/medline/citation/26155597/Risk_of_HIV_1_acquisition_among_women_who_use_diff_erent_types_of_injectable_progestin_contraception_in_South_Africa:_a_prospective_cohort_study_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2352-3018(15)00058-2 DB - PRIME DP - Unbound Medicine ER -