Hormonal Contraceptive Use among HIV-Positive Women and HIV Transmission Risk to Male Partners, Zambia, 1994-2012

• Type of Material: Article
• Authors: Kristin Wall, Emory University; William Kilembe, Emory University; Bellington Vwalika, Emory University; Preeti Ravindhran, Emory University; Naw Htee Khu, Emory University; Ilene Brill, University of Alabama at Birmingham; Elwyn Chomba, Emory University; Brent A. Johnson, University of Rochester; Lisa Haddad, Emory University; Amanda Tichacek, Emory University; Susan Allen, Emory University
• Language: English
• Date: 2016-10-01
• Publisher: Oxford University Press (OUP)
• Publication Version: Final Published Version
• Copyright Statement: © 2016 The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1093/infdis/jiw322
• Title of Journal or Parent Work: Journal of Infectious Diseases
• ISSN: 0022-1899
• Volume: 214
• Issue: 7
• Start Page: 1063
• End Page: 1071
• Grant/Funding Information: This work was supported by the National Institutes of Child Health and Development (R01 HD40125), National Institute of Mental Health (R01 66,767), the AIDS International Training and Research Program Fogarty International Center (D43 TW001042), the Emory Center for AIDS Research (P30 AI050409), the National Institute of Allergy and Infectious Diseases (R01 AI51231, R01 AI040951, R01 AI023980, R01 AI64060, and R37 AI51231), the Centers for Disease Control and Prevention (5U2GPS000758), the International AIDS Vaccine Initiative, and the US Agency for International Development.
• Keywords: hormonal contraception; Zambia; HIV discordant couples; HIV risk; longitudinal cohort
• Research Categories: Health Sciences, Epidemiology; Health Sciences, Obstetrics and Gynecology

Abstract

Background: Evidence on the association between female-to-male human immunodeficiency virus (HIV) transmission risk and hormonal contraception is sparse and conflicting. Methods: Heterosexual HIV-discordant couples from Lusaka, Zambia, were followed longitudinally at 3 month-intervals from 1994 to 2012. The impact of hormonal contraception on time to HIV transmission from HIV-positive women to their HIV-negative male partners (M-F+) was evaluated. Results: Among 1601 M-F+ couples, 171 genetically linked HIV transmissions occurred in men over 3216 couple-years (5.3 transmissions/100 couple-years; 95% confidence interval [CI], 4.5-6.2). In multivariable Cox models, neither injectable (adjusted hazard ratio [aHR], 0.6; 95% CI,. 4-1.2), oral contraceptive pill (aHR, 0.8; 95% CI,. 3-2.1), nor implant (aHR, 0.8; 95% CI,. 5-1.4) use was associated with HIV transmission, relative to nonhormonal methods, after controlling for the man's age at baseline and time-varying measures of pregnancy, self-reported unprotected sex with the study partner, sperm present on a vaginal swab wet mount, genital inflammation of either partner, genital ulceration of the man, and first follow-up interval. Sensitivity analyses, including marginal structural modeling and controlling for viral load and fertility intentions available in a subset of couples, led to similar conclusions. Conclusions: Our findings suggest null associations between hormonal contraception and risk of female-to-male HIV transmission. We support efforts to increase the contraceptive method mix for all women, regardless of HIV serostatus, along with reinforced condom counseling for HIV-serodiscordant couples.