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Withdrawing Depo-Provera contraceptives would result in more lives lost than HIV infections prevented
Roger Pebody, 2018-01-11 07:20

Even if Depo-Provera and other contraceptive injections raise the risk of HIV infection, withdrawing them from use in African countries would greatly increase maternal mortality, a modelling study has shown. The loss of life due to pregnancy complications and unsafe abortions would far outweigh the number of HIV infections prevented, according to the study published in the December issue of Global Health: Science and Practice.

Observational studies have produced conflicting evidence about a possible link between hormonal contraception – especially depot medroxyprogesterone acetate (DMPA, often marketed as Depo-Provera), a long-acting progesterone-only injectable – and women's risk of HIV infection. It’s not clear whether an apparent increase in HIV infections reflects a real biological effect of the contraceptive or if the results are skewed by factors which the researchers haven’t been able to fully take into account, particularly differences in the sexual behaviour of contraceptive users and non-users.

Pooling the results of these studies, a recent meta-analysis found that HIV-negative women using DMPA may be at increased risk of acquiring HIV, with a pooled hazard ratio of 1.4 (95% confidence interval 1.2-1.6). More definitive data is likely to come from ECHO, an ongoing randomised clinical trial, which may report results in 2019.

In the meantime, the World Health Organization recommends that DMPA and other long-acting progestogen-only injectables should remain accessible to women at high risk of HIV, “because the advantages of these methods generally outweigh the possible increased risk of HIV acquisition”. However, women at high risk of HIV who choose to use these methods should be counselled about the possible increased risk of HIV and how to reduce this risk.