Hormonal Contraception and the Risk of HIV Acquisition: An Individual Participant Data Meta-analysis

Charles S Morrison, Pai-Lien Chen, Cynthia Kwok, Jared M Baeten, Joelle Brown, Angela M Crook, Lut Van Damme, Sinead Delany-Moretlwe, Suzanna C Francis, Barbara A Friedland, Richard J Hayes, Renee Heffron, Saidi Kapiga, Quarraisha Abdool Karim, Stephanie Karpoff, Rupert Kaul, R Scott McClelland, Sheena McCormack, Nuala McGrath, Landon Myer, Helen Rees, Ariane van der Straten, Deborah Watson-Jones, Janneke H H M van de Wijgert, Randy Stalter and Nicola Low

PLOS Medicine, 2015, vol. 12, issue 1, 1-26

Abstract: In a meta-analysis of individual participant data, Charles Morrison and colleagues explore the association between hormonal contraception use and risk of HIV infection in sub-Saharan Africa.Background: Observational studies of a putative association between hormonal contraception (HC) and HIV acquisition have produced conflicting results. We conducted an individual participant data (IPD) meta-analysis of studies from sub-Saharan Africa to compare the incidence of HIV infection in women using combined oral contraceptives (COCs) or the injectable progestins depot-medroxyprogesterone acetate (DMPA) or norethisterone enanthate (NET-EN) with women not using HC. Methods and Findings: Eligible studies measured HC exposure and incident HIV infection prospectively using standardized measures, enrolled women aged 15–49 y, recorded ≥15 incident HIV infections, and measured prespecified covariates. Our primary analysis estimated the adjusted hazard ratio (aHR) using two-stage random effects meta-analysis, controlling for region, marital status, age, number of sex partners, and condom use. We included 18 studies, including 37,124 women (43,613 woman-years) and 1,830 incident HIV infections. Relative to no HC use, the aHR for HIV acquisition was 1.50 (95% CI 1.24–1.83) for DMPA use, 1.24 (95% CI 0.84–1.82) for NET-EN use, and 1.03 (95% CI 0.88–1.20) for COC use. Between-study heterogeneity was mild (I2

Date: 2015
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pmed00:1001778

DOI: 10.1371/journal.pmed.1001778

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