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Study Finds No Significant Difference in HIV Risk Based on Contraceptive Used

Jaime Rosenberg

Researchers of a phase 3 trial have concluded that there is so significant difference in risk of acquiring HIV based on what form of contraception a woman uses.

The randomized trial of more than 7800 women across Africa found that a form of injected contraception (intramuscular depot medroxyprogesterone acetate [DMPA-IM]) did not significantly increase the risk of acquiring HIV, compared with a copper intrauterine device (IUD) and a levonorgestrel (LNG) implant.

“Although no formal search was conducted, epidemiological studies over 30 years, conducted in various contexts, have suggested that women using some types of hormonal contraceptives, primarily DMPA-IM, might be at increased risk of HIV acquisition,” wrote the researchers, who noted their findings dispel the past work.

The researchers explained that they designed the study to detect a 50% increase in HIV incidence for each of the contraceptive methods compared with each of the others. “None of the comparisons in the primary modified intention-to-treat analysis showed a 50% increase in HIV incidence, and, under the design of this study an observed approximately 30% increase in HIV incidence would have been found to be statistically significant,” they wrote.

Results of the analysis revealed that the hazard ratios for HIV acquisition were 1.04 for DMPA-IM compared with the copper IUD, 1.23 for DMPA-IM compared with the LNG implant, and 1.18 for the copper IUD compared with the LNG implant.

Women aged 16 to 35 years who did not have HIV and were seeking contraception were enrolled in the study between December 14, 2015, and September 12, 2017, with follow-up for up to 18 months. Among the 7800 women randomized to the 3 contraceptive methods, 2556 women in the DMPA-IM group, 2571 women in the copper IUD group, and 2588 women in the LNG implant group were included in the modified intention-to-treat, primary analysis.

Throughout the study period, there were 397 incident HIV infections, of which 143 (36%) occurred in the DMPA-IM group, 138 (35%) occurred in the copper IUD group, and 116 (29%) occurred in the LNG implant group.

Overall HIV incidence was 3.81 per 100 women-years. Looking across contraceptive method, HIV incidence was 4.19 per 100 woman-years in the DMPIA-IM group, 3.94 per 100-woman years in the copper IUD group, and 3.31 per 100 woman-years in the LNG implant group.

“These results underscore the importance of continued and increased access to these three contraceptive methods, as well as expanded contraceptive choices, complemented by high-quality HIV and STI prevention services,” said Helen Rees, BA, MB BCh, DCH, MA, MRCGP, MRCOG, professor at Wits Reproductive Health and HIV Institute in South Africa and co-author of the study, in a statement.

The 3 forms of contraception were also well tolerated, with 219 (3%) women in any group reporting serious adverse events. There were 49 serious adverse events in the DMPA-IM group, 92 in the copper IUD group, and 78 in the LNG implant group. A total of 553 (7%) women had an adverse event leading to discontinuation of their contraceptive.

Reference
Baeten JM, Donnell D, Gichangi PB, et al. Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial Consortium. HIV incidence among women using intramuscular depot medroxyprogesterone acetate, a copper intrauterine device, or a levonorgestrel implant for contraception: a randomised, multicentre, open-label trial [published online June 13, 2019]. Lancet. doi: 10.1016/S0140-6736(19)31288-7.
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