Injectabletable contraceptive depo medroxyprogesterone acetate (DMPA) may increase the risk of contracting HIV by 40% in women, researchers have found.
The lead author of the review published in Endocrine Reviews, Professor Janet Hapgood from the University of Cape Town’s department of molecular and cell biology said alternative contraception methods may help protect women from contracting the virus.
Researchers said DMPA was “the major form of hormonal contraceptive used in sub-Saharan Africa, which also has the highest worldwide HIV prevalence, particularly in young women”.
“To protect individual and public health, it is important to ensure women in areas with high rates of HIV infection have access to affordable and safe contraceptive options,” Hapgood said.
According to the study, 31 observational studies assessed the risk of HIV infection among women using a hormonal contraceptive method.
“This evidence predominantly examined COCs (combined oral contraceptive) or progestogen-only injectable contraceptives (DMPA [intramuscular] and norethisterone enanthate).
“Scant data was available on the potential relationship between implant use and the risk of HIV.
“No study assessed the relationship with contraceptive vaginal rings, patches or levonorgestrel intrauterine devices,” the report stated in part.
Hapgood said the increased rate of HIV infection among women who use DMPA contraceptive shots was due to various reasons, including decreases in immune function and the protective barrier function of the female genital tract.
“Studying the biology of medroxyprogesterone acetate (MPA) helps us understand what may be driving the increased rate of HIV infection seen in human research,” said Hapgood.
The researchers said increasing the availability of contraceptives that use a different form of progestin than the one found in DMPA could help reduce the risk of HIV transmission.
“Other forms of contraception, including combined oral contraceptives containing levonorgestrel or the injectable contraceptive norethisterone enanthate, were not associated with an increased HIV infection risk.
“ individual progestins used in hormonal contraceptives have different biological effects via specific steroid receptors, and that oestrogen may exert a protective, antiviral effect.
“In a review of animal, cell and biochemical research on the form of progestin used in DMPA, researchers found evidence that supports a role for MPA in increasing the permeability of the female genital tract and promoting HIV,” the researchers said.
The researchers said the analysis had revealed that MPA suppresses plasmacytoid dendritic cell and T-cell function, as well as select regulators of cellular and humoral systemic immunity.
“Women and couples at high risk of HIV infection continue to be eligible to use all forms of hormonal contraception.
“Informed decision-making is a key organising principle and standard in a human rights-based approach to contraceptive information and services.
“A shared decision-making approach to contraceptive use should be taken with all individuals, but special attention should be paid to using this approach with vulnerable populations, such as women at high risk of acquiring HIV,” the report said.
The report stated that multiple actions were needed from the global health com- munity to address the twin epidemics of HIV and unintended pregnancy.