WHO: Hormonal contraceptives don’t increase risk of HIV infection

MANILA, Philippines — Medical experts are certain that the use of hormonal contraceptives does not increase one’s risk of acquiring the human immunodeficiency virus (HIV), the World Health Organization (WHO) said yesterday.

The WHO reported that a large clinical study done in four African countries found no significant difference in risk of HIV infection among women using one of three highly effective, reversible contraceptive methods. 

“We finally have robust scientific evidence about the potential relationship between hormonal contraception and the risk of HIV from a rigorous randomized clinical trial,” said professor Helen Rees, member of the five-person Evidence for Contraceptive Options and HIV Outcomes (ECHO) management committee that conducted the study.

Rees said while the results are reassuring the findings are also sobering because they confirm high HIV incidence among young African women.

For the past 25 years, the WHO said, a number of studies suggested a possible increased risk of HIV acquisition for women using progestogen-only injectables, particularly DMPA-intramuscular or DMPA-IM. 

“Because of limitations in the design of these studies, however, it was not possible to determine whether HIV infections were due to the type of contraceptive method used or other factors. The results of the ECHO trial are the most robust to date that address these concerns,” the WHO noted.

But the ECHO Study carried out in four countries with settings of high HIV incidence Eswatini, Kenya, South Africa and Zambia – indicated otherwise. 

The study involved a total of 7,829 sexually active HIV-negative women aged 16 to 35, who wanted to use a modern method of contraception.

 “The study showed that each method had high levels of safety and effectiveness in preventing pregnancy, with all methods well-accepted by the women using them,” the WHO said.

The three contraceptive methods investigated in the trial were DMPA-IM, Levonorgestrel implant and copper-bearing IUD.

DMPA-IM is a tri-monthly, progestogen-only, reversible injectable contraceptive.

Levonorgestrel implant is a progestogen-only implant inserted under the skin in the upper arm that can be used for up to five years.

Copper-bearing IUD is a device inserted into the uterus that can be used for up to 10 to 12 years.

The WHO said the study highlights the need to step up HIV prevention efforts in these high-burden countries, particularly for young women.

Rachel Baggaley from the WHO’s HIV and Hepatitis Department said programs should include providing HIV testing and a range of HIV prevention choices within contraceptive services.

Based on WHO data there are 214 million women in developing countries, who want to avoid pregnancy but do not use a modern contraceptive method. 

Regardless of the data from the ECHO trial, the WHO said, the limited choice of contraceptives that women have is not acceptable. 

“We hope that this result will prompt action and put women first. Women want more options beyond DMPA,” said Yvette Raphael, member of the Global Community Advisory Group for the ECHO Study.

Raphael said the findings support continued access to all the methods by women including those at high risk of HIV infection.

The WHO is set to convene a guideline development group to review its existing recommendations concerning women’s eligibility for using various contraceptive methods if they are at high risk of HIV. 

Updated recommendations will be issued by the end of August.