July 25, 2014
A sophisticated meta-analysis, pooling individual-level data on 37,000 women, has found that the use of DMPA injectable hormonal contraception is linked with a higher rate of new HIV infections in women, the 20th International AIDS Conference (AIDS 2014) in Melbourne heard today. However, the World Health Organization (WHO) announced at the same session that its guideline supporting the provision of this contraceptive to women at risk of HIV infection remains unchanged.
WHO reviewed research on the issue earlier this year, concluding that the data that were available at the time did not support restrictions on the use of injectable contraceptives, and agreed a new version of its guidance just a few days ago. However, they could not take into consideration the meta-analysis released today, nor a number of new studies which are expected to issue findings within the next year. WHO’s guidance will likely need to be reconsidered when those data are available.
The potential for some hormonal contraceptives to raise a woman’s risk of HIV infection has been the subject of scientific debate for several years. Around half the available studies suggest an increased risk, but half do not. Moreover, accurately assessing associations between contraceptive use and HIV infection with data from observational studies is challenging and analytically complex. Studies have used inconsistent approaches and generated a body of evidence that is complicated and difficult to interpret.
Furthermore, HIV is not the only consideration when it comes to contraceptive use. The broader health impact of fewer women using effective, long-acting contraceptives could be significant. In settings where maternal mortality is high due to complications of pregnancy or childbirth, effective contraception contributes to better health outcomes in women. Infants of mothers who die in childbirth have poorer health outcomes; closely spaced pregnancies contribute to infant mortality…