Hormonal contraceptive use and women's risk of HIV acquisition: a meta-analysis of observational studies
Summary Background The evidence from epidemiological research into whether use of hormonal contraception increases women's risk of HIV acquisition is inconsistent. We did a robust meta-analysis of existing data to provide summary estimates by hormonal contraceptive method which can be used to i...
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Veröffentlicht in: | The Lancet infectious diseases 2015-02, Vol.15 (2), p.181-189 |
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description | Summary Background The evidence from epidemiological research into whether use of hormonal contraception increases women's risk of HIV acquisition is inconsistent. We did a robust meta-analysis of existing data to provide summary estimates by hormonal contraceptive method which can be used to inform contraceptive guidelines, models, and future studies. Methods We updated a recent systematic review to identify and describe studies that met inclusion criteria. To ensure inclusion of more recent research, we searched PubMed for articles published after December, 2011, using the terms “hormonal contraception”, “HIV/acquisition”, “injectables”, “progestin”, and “oral contraceptive pills”. We assessed statistical heterogeneity for these studies, and, when appropriate, combined point estimates by hormonal contraception formulation using random-effects models. We assessed publication bias and investigated heterogeneity through subgroup and stratified analyses according to study population and design features. Findings We identified 26 studies, 12 of which met inclusion criteria. There was evidence of an increase in HIV risk in the ten studies of depot medroxyprogesterone acetate (pooled hazard ratio [HR] 1·40, 95% CI 1·16–1·69). This risk was lower in the eight studies done in women in the general population (pooled HR 1·31, 95% CI 1·10–1·57). There was substantial between-study heterogeneity in secondary analyses of trials (n=7, I2 51·1%, 95% CI 0–79·3). Although individual study estimates suggested an increased risk, substantial heterogeneity between two studies done in women at high risk of HIV infection ( I2 54%, 0–88·7) precluded pooling estimates. There was no evidence of an increased HIV risk in ten studies of oral contraceptive pills (pooled HR 1·00, 0·86–1·16) or five studies of norethisterone enanthate (pooled HR 1·10, 0·88–1·37). Interpretation Our findings show a moderate increased risk of HIV acquisition for all women using depot medroxyprogesterone acetate, with a smaller increase in risk for women in the general population. Whether the risks of HIV observed in our study would merit complete withdrawal of depot medroxyprogesterone acetate needs to be balanced against the known benefits of a highly effective contraceptive. Funding None. |
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We did a robust meta-analysis of existing data to provide summary estimates by hormonal contraceptive method which can be used to inform contraceptive guidelines, models, and future studies. Methods We updated a recent systematic review to identify and describe studies that met inclusion criteria. To ensure inclusion of more recent research, we searched PubMed for articles published after December, 2011, using the terms “hormonal contraception”, “HIV/acquisition”, “injectables”, “progestin”, and “oral contraceptive pills”. We assessed statistical heterogeneity for these studies, and, when appropriate, combined point estimates by hormonal contraception formulation using random-effects models. We assessed publication bias and investigated heterogeneity through subgroup and stratified analyses according to study population and design features. Findings We identified 26 studies, 12 of which met inclusion criteria. There was evidence of an increase in HIV risk in the ten studies of depot medroxyprogesterone acetate (pooled hazard ratio [HR] 1·40, 95% CI 1·16–1·69). This risk was lower in the eight studies done in women in the general population (pooled HR 1·31, 95% CI 1·10–1·57). There was substantial between-study heterogeneity in secondary analyses of trials (n=7, I2 51·1%, 95% CI 0–79·3). Although individual study estimates suggested an increased risk, substantial heterogeneity between two studies done in women at high risk of HIV infection ( I2 54%, 0–88·7) precluded pooling estimates. There was no evidence of an increased HIV risk in ten studies of oral contraceptive pills (pooled HR 1·00, 0·86–1·16) or five studies of norethisterone enanthate (pooled HR 1·10, 0·88–1·37). Interpretation Our findings show a moderate increased risk of HIV acquisition for all women using depot medroxyprogesterone acetate, with a smaller increase in risk for women in the general population. Whether the risks of HIV observed in our study would merit complete withdrawal of depot medroxyprogesterone acetate needs to be balanced against the known benefits of a highly effective contraceptive. Funding None.</description><identifier>ISSN: 1473-3099</identifier><identifier>EISSN: 1474-4457</identifier><identifier>DOI: 10.1016/S1473-3099(14)71052-7</identifier><identifier>PMID: 25578825</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>United States: Elsevier Ltd</publisher><subject>Adult ; Birth control ; Contraceptive Agents, Female - adverse effects ; Drugs ; Estimates ; Female ; Health risks ; Heterogeneity ; HIV Infections - epidemiology ; Humans ; Infections ; Infectious Disease ; Infectious diseases ; Medroxyprogesterone Acetate - adverse effects ; Middle Aged ; Mortality ; Observational studies ; Public health ; Risk Assessment ; Sensitivity analysis ; Studies ; Womens health</subject><ispartof>The Lancet infectious diseases, 2015-02, Vol.15 (2), p.181-189</ispartof><rights>Elsevier Ltd</rights><rights>2015 Elsevier Ltd</rights><rights>Copyright © 2015 Elsevier Ltd. All rights reserved.</rights><rights>Copyright Elsevier Limited Feb 2015</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c561t-36ebe6b97003d97b47b72e10f93ca8e28bcfe96e4915293bebc4235699c785343</citedby><cites>FETCH-LOGICAL-c561t-36ebe6b97003d97b47b72e10f93ca8e28bcfe96e4915293bebc4235699c785343</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/1646412562?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64389,72469</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25578825$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ralph, Lauren J, MPH</creatorcontrib><creatorcontrib>McCoy, Sandra I, PhD</creatorcontrib><creatorcontrib>Shiu, Karen, MPH</creatorcontrib><creatorcontrib>Padian, Nancy S, PhD</creatorcontrib><title>Hormonal contraceptive use and women's risk of HIV acquisition: a meta-analysis of observational studies</title><title>The Lancet infectious diseases</title><addtitle>Lancet Infect Dis</addtitle><description>Summary Background The evidence from epidemiological research into whether use of hormonal contraception increases women's risk of HIV acquisition is inconsistent. We did a robust meta-analysis of existing data to provide summary estimates by hormonal contraceptive method which can be used to inform contraceptive guidelines, models, and future studies. Methods We updated a recent systematic review to identify and describe studies that met inclusion criteria. To ensure inclusion of more recent research, we searched PubMed for articles published after December, 2011, using the terms “hormonal contraception”, “HIV/acquisition”, “injectables”, “progestin”, and “oral contraceptive pills”. We assessed statistical heterogeneity for these studies, and, when appropriate, combined point estimates by hormonal contraception formulation using random-effects models. We assessed publication bias and investigated heterogeneity through subgroup and stratified analyses according to study population and design features. Findings We identified 26 studies, 12 of which met inclusion criteria. There was evidence of an increase in HIV risk in the ten studies of depot medroxyprogesterone acetate (pooled hazard ratio [HR] 1·40, 95% CI 1·16–1·69). This risk was lower in the eight studies done in women in the general population (pooled HR 1·31, 95% CI 1·10–1·57). There was substantial between-study heterogeneity in secondary analyses of trials (n=7, I2 51·1%, 95% CI 0–79·3). Although individual study estimates suggested an increased risk, substantial heterogeneity between two studies done in women at high risk of HIV infection ( I2 54%, 0–88·7) precluded pooling estimates. There was no evidence of an increased HIV risk in ten studies of oral contraceptive pills (pooled HR 1·00, 0·86–1·16) or five studies of norethisterone enanthate (pooled HR 1·10, 0·88–1·37). Interpretation Our findings show a moderate increased risk of HIV acquisition for all women using depot medroxyprogesterone acetate, with a smaller increase in risk for women in the general population. Whether the risks of HIV observed in our study would merit complete withdrawal of depot medroxyprogesterone acetate needs to be balanced against the known benefits of a highly effective contraceptive. Funding None.</description><subject>Adult</subject><subject>Birth control</subject><subject>Contraceptive Agents, Female - adverse effects</subject><subject>Drugs</subject><subject>Estimates</subject><subject>Female</subject><subject>Health risks</subject><subject>Heterogeneity</subject><subject>HIV Infections - epidemiology</subject><subject>Humans</subject><subject>Infections</subject><subject>Infectious Disease</subject><subject>Infectious diseases</subject><subject>Medroxyprogesterone Acetate - adverse effects</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Observational studies</subject><subject>Public health</subject><subject>Risk Assessment</subject><subject>Sensitivity analysis</subject><subject>Studies</subject><subject>Womens health</subject><issn>1473-3099</issn><issn>1474-4457</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNqFkE1v1DAQhiMEoqXwE0CWOACHgD_juAcQqoCtVIkDH1fLdibC7SbeepJF--9xNgUkLpzGsp95xvNW1VNGXzPKmjdfmNSiFtSYl0y-0owqXut71Wm5lrWUSt8_nlfkpHqEeE0pK5x8WJ1wpXTbcnVa_dikPKTRbUlI45RdgN0U90BmBOLGjvxMA4wvkOSINyT1ZHP5nbhwO0eMU0zjOXFkgMnVrigOGHFhkkfIe7e8Fy9OcxcBH1cPerdFeHJXz6pvHz98vdjUV58_XV68v6qDathUiwY8NN5oSkVntJfaaw6M9kYE1wJvfejBNCANU9wIDz5ILlRjTNCtElKcVc9X7y6n2xlwstdpzuUjaFkjG8m4anih1EqFnBAz9HaX4-DywTJql3ztMV-7hGeZtMd8rS59z-7ssx-g-9P1O9ACvFsBKDvuI2SLIcIYoIsZwmS7FP874u0_hrCNYwxuewMHwL_bWOSWrpLFUepi0OIXeMufQw</recordid><startdate>20150201</startdate><enddate>20150201</enddate><creator>Ralph, Lauren J, MPH</creator><creator>McCoy, Sandra I, PhD</creator><creator>Shiu, Karen, MPH</creator><creator>Padian, Nancy S, PhD</creator><general>Elsevier Ltd</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0TZ</scope><scope>3V.</scope><scope>7QL</scope><scope>7RV</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8C2</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>C1K</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope></search><sort><creationdate>20150201</creationdate><title>Hormonal contraceptive use and women's risk of HIV acquisition: a meta-analysis of observational studies</title><author>Ralph, Lauren J, MPH ; McCoy, Sandra I, PhD ; Shiu, Karen, MPH ; Padian, Nancy S, PhD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c561t-36ebe6b97003d97b47b72e10f93ca8e28bcfe96e4915293bebc4235699c785343</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Birth control</topic><topic>Contraceptive Agents, Female - adverse effects</topic><topic>Drugs</topic><topic>Estimates</topic><topic>Female</topic><topic>Health risks</topic><topic>Heterogeneity</topic><topic>HIV Infections - epidemiology</topic><topic>Humans</topic><topic>Infections</topic><topic>Infectious Disease</topic><topic>Infectious diseases</topic><topic>Medroxyprogesterone Acetate - adverse effects</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Observational studies</topic><topic>Public health</topic><topic>Risk Assessment</topic><topic>Sensitivity analysis</topic><topic>Studies</topic><topic>Womens health</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ralph, Lauren J, MPH</creatorcontrib><creatorcontrib>McCoy, Sandra I, PhD</creatorcontrib><creatorcontrib>Shiu, Karen, MPH</creatorcontrib><creatorcontrib>Padian, Nancy S, PhD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Pharma and Biotech Premium PRO</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Nursing & Allied Health Database</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Lancet Titles</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><jtitle>The Lancet infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ralph, Lauren J, MPH</au><au>McCoy, Sandra I, PhD</au><au>Shiu, Karen, MPH</au><au>Padian, Nancy S, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Hormonal contraceptive use and women's risk of HIV acquisition: a meta-analysis of observational studies</atitle><jtitle>The Lancet infectious diseases</jtitle><addtitle>Lancet Infect Dis</addtitle><date>2015-02-01</date><risdate>2015</risdate><volume>15</volume><issue>2</issue><spage>181</spage><epage>189</epage><pages>181-189</pages><issn>1473-3099</issn><eissn>1474-4457</eissn><coden>LANCAO</coden><abstract>Summary Background The evidence from epidemiological research into whether use of hormonal contraception increases women's risk of HIV acquisition is inconsistent. We did a robust meta-analysis of existing data to provide summary estimates by hormonal contraceptive method which can be used to inform contraceptive guidelines, models, and future studies. Methods We updated a recent systematic review to identify and describe studies that met inclusion criteria. To ensure inclusion of more recent research, we searched PubMed for articles published after December, 2011, using the terms “hormonal contraception”, “HIV/acquisition”, “injectables”, “progestin”, and “oral contraceptive pills”. We assessed statistical heterogeneity for these studies, and, when appropriate, combined point estimates by hormonal contraception formulation using random-effects models. We assessed publication bias and investigated heterogeneity through subgroup and stratified analyses according to study population and design features. Findings We identified 26 studies, 12 of which met inclusion criteria. There was evidence of an increase in HIV risk in the ten studies of depot medroxyprogesterone acetate (pooled hazard ratio [HR] 1·40, 95% CI 1·16–1·69). This risk was lower in the eight studies done in women in the general population (pooled HR 1·31, 95% CI 1·10–1·57). There was substantial between-study heterogeneity in secondary analyses of trials (n=7, I2 51·1%, 95% CI 0–79·3). Although individual study estimates suggested an increased risk, substantial heterogeneity between two studies done in women at high risk of HIV infection ( I2 54%, 0–88·7) precluded pooling estimates. There was no evidence of an increased HIV risk in ten studies of oral contraceptive pills (pooled HR 1·00, 0·86–1·16) or five studies of norethisterone enanthate (pooled HR 1·10, 0·88–1·37). Interpretation Our findings show a moderate increased risk of HIV acquisition for all women using depot medroxyprogesterone acetate, with a smaller increase in risk for women in the general population. Whether the risks of HIV observed in our study would merit complete withdrawal of depot medroxyprogesterone acetate needs to be balanced against the known benefits of a highly effective contraceptive. Funding None.</abstract><cop>United States</cop><pub>Elsevier Ltd</pub><pmid>25578825</pmid><doi>10.1016/S1473-3099(14)71052-7</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Adult Birth control Contraceptive Agents, Female - adverse effects Drugs Estimates Female Health risks Heterogeneity HIV Infections - epidemiology Humans Infections Infectious Disease Infectious diseases Medroxyprogesterone Acetate - adverse effects Middle Aged Mortality Observational studies Public health Risk Assessment Sensitivity analysis Studies Womens health |
title | Hormonal contraceptive use and women's risk of HIV acquisition: a meta-analysis of observational studies |
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