Effect of Contraceptive Methods on Natural History of HIV: Studies from the Mombasa Cohort

HIV disease progression by hormonal contraceptive method: secondary analysis of a randomized trial

“…[6] That study found the IUD to be safe and effective, but subsequent analysis indicated women allocated to the hormonal contraception control arm had faster progression of their HIV disease (based on death and decline in CD4+ count). This finding corroborated by other research in both macaques [7] and humans [8] suggests a link between progesterone exposure and both HIV acquisition and faster disease progression. We therefore hypothesized that progesterone might be primarily responsible for study’s observation and sought to examine the question in greater detail.…”

REVIEW ARTICLE: HIV Infection in the Female Genital Tract: Discrete Influence of the Local Mucosal Microenvironment

“…61 Multiple studies in humans and rhesus macaques suggest that the use of progesterone-based formulations may predispose one to increased risk of HIV-1 or SIV infection, higher viral burden and increased viral shedding. [62][63][64] A recent study further suggested that women who use progesterone-based contraceptives display accelerated HIV-1 disease progression and mortality, compared to women who do not. 65 Although the pathways involved in these outcomes are not clear, progesterone is known to regulate a number of immunological pathways, including the inhibition of CTLs and natural killer cells.…”

Influence of Common Mucosal Co‐Factors on HIV Infection in the Female Genital Tract

“…69 Human epidemiological studies have shown that DMPA use may lead to increased risk of HIV-1 infection, disease progression, and mortality compared to women who did not use the injectable contraceptive formulation DMPA. 65,[70][71][72] More recently, a prospective cohort study of nearly 3800 serodiscordant couples from seven African nations found that the risk of acquiring HIV from an infected male partner was twice as high among women who used injectable hormonal contraceptives and that HIV-infected women who used injectable hormonal contraceptive were twice as likely to transmit HIV to an uninfected male partner. 73 Subsequently, UNAIDS had urgent consultations with an expert panel, and although guidelines for hormonal contraceptive were not subsequently altered, there was a renewed call for more research on hormonal contraceptives and HIV infection risk.…”