Risk of HIV-1 acquisition among women who use different types of injectable progestin contraception in South Africa: a prospective cohort study

摘要: Summary Background Several observational studies have reported that HIV-1 acquisition seems to be higher in women who use depot medroxyprogesterone acetate (DMPA) than those do not hormonal contraception. We aimed assess whether two injectable progestin-only contraceptives, DMPA and norethisterone enanthate (NET-EN), confer different risks of acquisition. Methods included data from South African used contraception while participating the VOICE study, a multisite, randomised, placebo-controlled trial investigated safety efficacy three formulations tenofovir for prevention infection between Sept 9, 2009, Aug 13, 2012. Women were assessed monthly contraceptive incident infection. estimated difference NET-EN users by Cox proportional hazards regression analyses this prospective cohort. The is registered with ClinicalTrials.gov, NCT00705679. Findings 3141 using present analysis: 1788 (56·9%) solely DMPA, 1097 (34·9%) NET-EN, 256 (8·2%) both types at times during follow-up. During 2733·7 person-years follow-up, 207 infections occurred (incidence 7·57 per 100 person-years, 95% CI 6·61–8·68). Risk was among 8·62 7·35–10·11) (5·67 4·35–7·38; hazard ratio 1·53, 1·12–2·08; p=0·007). This association persisted when adjusted potential confounding variables (adjusted [aHR] 1·41, 1·06–1·89; p=0·02). Among seropositive herpes simplex virus type 2 (HSV-2) enrolment, aHR 2·02 (95% 1·26–3·24) compared 1·09 (0·78–1·52) HSV-2-seronegative (p interaction =0·07). Interpretation Although moderate associations should interpreted caution, these findings suggest might an alternative drug lower HIV risk high incidence settings where available. Funding National Institutes Health, Mary Meyer Scholars Fund, Ruth Freeman Memorial Fund.