HIV acquisition is 3.5x higher in women using depoprovera

Welcome back after a nice holiday break. Today, I want to alert you to a new Lancet ID paper from Doug Kwon’s group here at Mass General.  Its an important study demonstrating that HIV acquisition is 3.5x higher in South African women using depoprovera (the most common contraceptive in sub-saharan Africa). The study was conducted in Umlazi, a large township outside of Durban.

Doug Kwon emailed me about the article:

“The study is unique that it examines the immunologic mechanism for HIV acquisition. There is significant controversy in this area of research. Although some studies have shown an epidemiologic association of injectable progestin contraceptives (IPCs) with increased HIV acquisition, the observation has not been consistent. We believe one reason is that in large groups of women, IPC use is associated with less behavioral risk of HIV (eg older age, married, stable relationship, already with kids, etc) and that this may mask some of the biological effects of IPCs. Our study was limited to women 18-23 and behavioral risk factors were very evenly matched between IPCs users and those not using any long term contraception. Another unique aspect of our study was that we were able to examine immunologic mucosal factors associated with this increased risk and we found higher levels of activated CD4 T cells (“HIV target cells”) in the female genital tract of IPC users. This increased target cell frequency at the site of initial HIV exposure may be why these women are acquiring HIV at higher rates.”

I imagine Doug’s study will be discussed at next month’s CROI meeting. How many South African clinicians are still giving depoprovera? Are there other methods of birth control that are feasible and affordable in this context? We must stop HIV transmission, if we have any hope of ending this pandemic.

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Umlazi, Durban, South Africa
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Umlazi, Durban, South Africa

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