Hormonal contraception and the risk of HIV acquisition in women
9 August 2016 : The World Health Organization will convene an expert review group later in 2016 to examine the links between the use of various hormonal contraceptive methods and women’s risk of HIV acquisition. The expert review group will assess whether current WHO guidance needs to change in the light of a new review of data, published in AIDS on 9 August 2016, which was commissioned by WHO.
For the past 25 years, there has been mixed evidence as to whether use of hormonal contraceptive methods (particularly depot medroxyprogesterone acetate [DMPA]) is associated with a woman’s risk of acquiring HIV. WHO is committed to engaging with stakeholders and has been continuously monitoring and reviewing new evidence and providing guidance accordingly. WHO commissioned this systematic review to analyse findings from all studies published in the past two years and to synthesize them with the previous evidence published in 2014.
In addition to the previously available evidence, the systematic review analysed ten new studies. Reassuringly, it found that most of the data for oral contraceptive pills, injectable norethisterone enanthate (NET-EN), and levonorgestrel implants continue to indicate no association with risk of HIV acquisition. These new data, however, do strengthen existing concerns about a possible increase in risk of HIV acquisition in women using injectable DMPA, although the statistical significance of these studies varies and they are observational in nature. A research consortium is currently undertaking a randomised trial to compare the risks of HIV acquisition among women using different contraceptive methods. The trial will provide evidence as to whether using any of these methods causes an increased risk of women acquiring HIV. The results from this research will not be available for several years.
Evaluating emerging evidence is extremely important to determine what guidance should be given to women, particularly in sub-Saharan Africa where high rates of HIV coincide with high use of DMPA injectable contraception.
WHO is concerned that access to preferred contraceptive methods for women, their partners, and for couples, is maximised, while protecting women’s health and that of their communities. Women have the right to the latest and best information and to access their preferred options when choosing a contraceptive method that is safe, effective and acceptable.