Long-term Effect of Depot Medroxyprogesterone Acetate on Vaginal Microbiota, Epithelial Thickness and HIV Target Cells

Background. Depot medroxyprogesterone acetate (DMPA) has been linked to human immunodeficiency virus type 1 (HIV-1) acquisition. Methods. Vaginal microbiota of women using DMPA for up to 2 years were cultured. Mucosal immune cell populations were measured by immunohistological staining. Results. Over 12 months, the proportion with H₂O₂-positive lactobacilli decreased (n = 32; 53% vs 27%; P = .03). Median vaginal CD3⁺ cells also decreased (n = 15; 355 vs 237 cells/mm²; P=.03), as did CD3⁺CCR5⁺ cells (195 vs 128 cells/mm²; P = .04), HLA-DR⁺ cells (130 vs 96 cells/mm²; P = .27), and HLA-DR⁺CCR5⁺ cells (18 vs 10 cells/mm²; P = .33). Conclusions. DMPA contraception does not increase vaginal mucosal CCR5⁺ HIV target cells but does decrease CD3⁺ T lymphocytes and vaginal H₂O₂-producing lactobacilli.