Update on the Impact of Depot Medroxyprogesterone Acetate on Vaginal Mucosal Endpoints and Relevance to Sexually Transmitted Infections

• Type of Material: Article
• Authors: Smritee Dabee, Seattle Children’s Research Institute; Christina Balle, University of Cape Town; Maricianah Onono, Kenya Medical Research Institute; Steve Innes, Desmond Tutu Health Foundation; Gonasagrie Nair, Desmond Tutu Health Foundation; Thesla Palanee-Phillips, University of Witwatersrand; Adam D Burgener, Case Western Reserve University; Steven E Bosinger, Emory University; Jo-Ann S Passmore, University of Cape Town; Renee Heffron, University of Alabama Birmingham; Heather Jaspan, University of Cape Town; Anna-Ursula Happel, University of Cape Town
• Language: English
• Date: 2023-06-21
• Publisher: SPRINGER
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2023
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1007/s11904-023-00662-0
• Title of Journal or Parent Work: CURRENT HIV/AIDS REPORTS
• Volume: 20
• Issue: 4
• Start Page: 251
• End Page: 260
• Grant/Funding Information: Open access funding provided by University of Cape Town. This work was supported by grants from the Bill and Melinda Gates Foundation (grant number INV-027876) and the US National Institute of Child Health and Human Development (grant number R01HD089831-05). Anna-Ursula Happel is supported by a European and Developing Countries Clinical Trials Partnership (EDCTP) Career Development Fellowship (CDF), which is part of the EDCTP2 programme supported by the European Union (grant number TMA2020CDF-3192-VaViBa). Christina Balle was supported by bursary funds from the Poliomyelitis Research Foundation (fund number 17/43) during her Ph.D. work. Renee Heffron received funding from the National Institutes of Health (grant number K24MH123371).
• Keywords: RISK; INFLAMMATION; Depot medroxyprogesterone acetate; BACTERIAL VAGINOSIS; ECHO Trial; ENDOMETRIUM; T-CELLS; Infectious Diseases; Inflammation; HORMONAL CONTRACEPTION; Epithelial barrier; HIV ACQUISITION; FEMALE GENITAL-TRACT; AFRICAN WOMEN; IMMUNE MEDIATORS; Vaginal microbiome; Life Sciences & Biomedicine; Immune cells; Science & Technology
• Research Categories: Health Sciences, Pathology; Health Sciences, Public Health; Biology, Microbiology

Abstract

Purpose of Review: The long-acting reversible intramuscularly-injected contraceptive depot medroxyprogesterone acetate (DMPA-IM) is widely used by cisgender women in Africa. Although DMPA-IM provides reliable contraception, potential effects on the female genital tract (FGT) mucosa have raised concern, including risk of HIV infection. This review summarises and compares evidence from observational cohort studies and the randomised Evidence for Contraceptive Options in HIV Outcomes (ECHO) Trial. Recent Findings: Although previous observational studies found women using DMPA-IM had higher abundance of bacterial vaginosis (BV)-associated bacteria, increased inflammation, increased cervicovaginal HIV target cell density, and epithelial barrier damage, sub-studies of the ECHO Trial found no adverse changes in vaginal microbiome, inflammation, proteome, transcriptome, and risk of viral and bacterial STIs, other than an increase in Th17-like cells. Summary: Randomised data suggest that DMPA-IM use does not adversely change mucosal endpoints associated with acquisition of infections. These findings support the safe use of DMPA-IM in women at high risk of acquiring STIs, including HIV. Graphical Abstract: [Figure not available: see fulltext.].