HIV, progestins, genital epithelial barrier function, and the burden of objectivity

Contributions from a diverse set of scientific disciplines will be needed to help individuals make fully informed decisions regarding contraceptive choices least likely to promote HIV susceptibility. This commentary recaps contrasting interpretations of results from the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial, a study that compared HIV risk in women using the progestin-only injectable contraceptive depot medroxyprogesterone acetate (DMPA) vs. two other contraceptive choices. It also summarizes results from basic and translational research that establish biological plausibility for earlier clinical studies that identified enhanced HIV susceptibility in women using DMPA. Summary sentence Basic and translational research studies provide strong indication that the contraceptive depot medroxyprogesterone acetate weakens genital mucosal barrier function, a vital first-line defense against HIV and other sexually transmitted pathogens.