Hormonal Contraception Use and Risk of Female-to-Male HIV Transmission Risk in a Zambian Cohort

Abstract

Background: The association between hormonal contraception (HC) use and risk of both male-to-female and female-to-male transmission HIV transmission is highly debated. Very little data exists related to female-to-male transmission risk and HC use. USAID FHI360 and the World Health Organization have called for more evaluations of this association. Methods: HIV discordant couples in which the man was negative and the woman was positive (M-F+) were identified after couples voluntary HIV counseling and testing from 1995-2012 in Lusaka Zambia. Discordant couples were followed longitudinally and demographic behavioral clinical and family planning measures were collected at baseline and 3-monthly. Men were re-tested for HIV every three months. Multivariate Cox models evaluated time to HIV acquisition among men. Results: Among 1654 M-F+couples 226 incident infections occurred over 3366 couple-years (6.71/100 couple-years; 95%CI: 5.87-7.65). 171 (76%) infections were genetically linked to the study partner. No interaction between genital ulceration/inflammation and contraception was observed. Use of injectables (HR=0.7; 95%CI:0.4-1.4) OCPs (HR=1.3; 95%CI:0.7-2.1) or implants (HR=0.8; 95%CI:0.2-2.8) in the past three months was not associated with genetically linked HIV transmission from women to men relative to non-HC controlling for: womans age number of previous pregnancies womans log viral load at baseline male circumcision status pregnancy status sex frequency with and without a condom sperm on a wet mount male and female genital inflammation and ulceration and time interval since enrollment. Conclusions: Our results add to a small and inconclusive body of literature. Over 17 years of follow-up we found no statistically significant association between HC use and female-to-male HIV transmission. These findings support the continued use of HC methods for pregnancy prevention and Prong 2 of PMTCT.