WHO to convene expert review on hormonal contraceptives

16 August 2016

Heightened concerns regarding the link between the hormonal contraceptive, Depo-Provera, and the risk of HIV acquisition in women after new systematic review released.

The World Health Organization (WHO) has announced that it will convene an expert review on the use of various hormonal contraception methods and whether they increase a woman’s chances of acquiring HIV. The expert group will convene later in 2016 and assess whether or not WHO guidelines need to change.

The announcement comes after the publication of a new systematic review undertaken by the Guttmacher Institute and the WHO. Evidence from this review suggests that some hormonal contraceptives, particularly depot medroxyprogesterone acetate – commonly known as Depo-Provera, may put women at greater risk of  HIV. Concerns about this link have been raised for some years, but new evidence has strengthened these worries.

Depo-Provera is often the only form of hormonal contraceptive available to women living in countries across sub-Saharan Africa, where HIV prevalence is highest. Dr Chelsea Polis, senior research scientist at the Guttmacher Institute and the review’s lead author said: “This is a critical area of research, given that hormonal contraceptives are highly effective methods for preventing unintended pregnancy and its health risks.”

She continued, “Many places where HIV rates are high also have high levels of unmet need for contraception, unintended pregnancy and maternal mortality. It is essential that we understand whether use of any particular hormonal contraceptive method could elevate women’s risk of HIV acquisition.”

It remains unclear if the relationship between HIV and Depo-Provera is causal as this latest evidence comes from observational studies, vulnerable to methodological bias. Moreover, if there is a link, further investigation will be needed to determine whether it is behavioural or biological.

The systematic review, published ahead-of-print in AIDS last week (6 August), updates a previous review conducted in 2014, incorporating the newest evidence available from 2014 to 2016.

Like the previous review, it finds no increased risk of HIV acquisition among women who used oral contraceptives pills. In a positive development, new and improved evidence on injectable norethisterone enanthate (NET-EN) found no link between this hormonal contraceptive and HIV, which the previous review had. While data on implants were limited, they also suggested no increased risk of HIV acquisition for women using levonorgestrel intrauterine devices (LNG-IUDs). There is currently no evidence on hormonal patches and vaginal rings.

Photo credit:
©Albert González Farran/UNAMID. Photos used for illustrated purposes only. They do not imply the health status of any person in the photo.

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