In a report of the most recent study, Heffron and coworkers analyzed data from 3,790 serodiscordant couples and found that women who used DMPA were, on average, twice as likely to acquire HIV and to transmit HIV as women who did not use DMPA. The number of seroconversions in the study was, however, low—13 women and 19 men—and investigators did not give information about the duration of DMPA use.
Furthermore, this study was a secondary analysis of a cohort study designed to assess the role of herpes simplex virus in HIV acquisition; it was not designed with the question of a DMPA-HIV link in mind. That leaves questions about contraceptive use, duration of such use, and associated sexual behavior unanswered.
In short, this study adds to an important, growing body of literature, but does not provide evidence for changing gynecologic practice regarding DMPA use and eligibility.
WHAT THIS EVIDENCE MEANS FOR PRACTICE
No study has clearly demonstrated sufficiently strong evidence of a putative link between DMPA use and an increased rate of HIV transmission in women at high risk of HIV disease for you to discourage its use in any of your patients for whom DMPA is appropriate.
Stakeholders at the WHO’s 2012 meeting on this matter concluded that 1) no change to guidelines is warranted and 2) hormonal contraception should be promoted for all women, regardless of HIV risk. That conclusion takes into account the fact that the results of more than a decade of research on the role of hormonal contraception in HIV acquisition have been equivocal.12
Given the well-known benefits of effective contraception in preventing unintended pregnancy for all women, especially those at risk of transmitting HIV, you should continue to promote DMPA and all other formulations and methods of hormonal contraception to eligible women.
HAVE YOU READ THESE ARTICLES ON CONTRACEPTION?
Click here to find 7 additional articles on contraception published in OBG Management in 2012.
We want to hear from you! Tell us what you think.