The complexity of contraceptives

Abstract

The same populations of women at risk for sexual acquisition of HIV are also at risk for pregnancy; many of these women use contraception. Combating the spread of HIV is a major global goal [1] ideally achievable with development of highly effective dual protection methods that prevent both sexual acquisition of HIV and unwanted pregnancy. Currently emerging evidence [2] suggests that some commonly used contraceptives may increase risk of sexual HIV acquisition and transmission. There are several biologically plausible mechanisms by which hormonal contraceptives could increase HIV risk including disrupting epithelial barriers (thinning of the epithelium or altering epithelial integrity) causing changes in inflammatory responses that could in turn enhance HIV replication locally [3] or altering the vaginal microbiota which itself effects local immunity and genital inflammation. The objective of this manuscript is to review the evidence linking contraceptives to genital tract changes and to identify research gaps to be addressed with future studies.