Bloodborne HIV: Don't Get Stuck!

Beginning in the mid-1990s, researchers saw that women using Depo-Provera (Depo) were more likely to get HIV compared to women who didn’t use Depo. More than a dozen studies over the next several decades recorded new HIV infections in women using or not using Depo.

During 2015-16, four research teams reviewed evidence from decades of research on women’s HIV risk with Depo. Here’s what they found:

1. Ralph and co-authors, Lancet Infection Diseases 2015: Women using Depo were 40% more likely to get new HIV infections compared to women not using any hormonal contraception method. The review looked at 10 studies published during 2003-14.[1]

2. Morrison and co-authors, PLoS Medicine 2015: Women using Depo were 50% more likely to get new HIV infections compared to women not using any hormonal contraception. The review compiled evidence from 18 studies that saw 1,830 new HIV infections in 37,124 women followed for up to 3 years during 1993-2012.[2]

3. Brind and co-authors, Issues in Law and Medicine 2015: Women using Depo (including in some cases some women using other steroid injections) were 49% more likely to get new HIV infections compared to women not using steroids for contraception (eg, no birth control, pills without steroids). The review looked at 16 studies published during 1994-2014.[3]

4. Polis and co-authors, AIDS 2016: Women using Depo were 40% more likely to get new HIV infections compared to women not using hormonal contraception. The review looked at 9 studies published during 2007-15.[4]

The active chemical in Depo – depo medroxyprogesterone acetate or DMPA – is similar to a natural hormone, progesterone. However, DMPA is not exactly the same. Specific differences between natural progesterone and DMPA may explain why Depo injections increase women’s risk to get HIV whereas some other injections for birth control (eg, NET EN) don’t seem to do so[5].

Depo weakens bones

The United Stated (US) Food and Drug Administration (FDA) requires anyone giving women Depo in the US to warn them that Depo use weakens their bones. This “black box” warning reads:[6]

Other side effects: irregular bleeding, weight gain, some cancers

Many women taking Depo have irregular bleeding, weight gain (reported average weight gain of >6 kg in 4 years), and other problems. It has also been linked to an increase in some cancers.[6]

Other side effects: higher risk to transmit HIV to partner

If a woman is HIV-positive Depo use may increase the risk she will infect her sex partners. One study found that women who were HIV-positive and used Depo were almost twice as likely to infect their husbands compared to women who did not use Depo.[7]

References

1. Ralph LR, McCoy SI, Shiu K, Padian N. Hormonal contraception use and women’s risk of HIV acquisition: a meta-analysis of observational studies. Lancet Infect Dis 2015; 15: 181-89. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4526270/ (accessed 5 March 2018).

2. Morrison CS. Chen P-L. Kwok C, et al. Hormonal contraception and the risk of HIV acquisition: an individual participant meta-analysis. PLoS Medicine 2015. Available at: https://doi.org/10.1371/journal.pmed.1001778. (accessed 5 March 2018).

3. Brind J, Condly SJ, Mosher SW, et al. Risk of HIV infection in depo-medroxyprogesterone acetate (DMPA) users: a systematic review and meta-analysis. Issues in Law and Medicine 2015; 30: 129-138. Abstract available at: https://www.ncbi.nlm.nih.gov/pubmed/?term=brind+condly+mosher (accessed 5 March 2018). More results from this review are at: Depo-Provera and HIV. PRI, no date. Available at: https://www.pop.org/depo-provera-and-hiv/ (accessed 6 March 2018).

4. Polis CB, Curtis KM, Hannaford PC, et al. An updated systematic review of epidemiological evidence on hormonal contraceptive methods and HIV acquisition in women. AIDS 2016; 30: 2665-2683. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5106090/ (accessed 5 March 2018).

5. Hapgood JP, Kaushic C. Hel Z. Hormonal contraception and HIV-1 acquisition: biological mechanisms. Available at: https://academic.oup.com/edrv/article/39/1/36/4788769 (accessed 4 March 2018).

6. FDA. Full prescribing information [for Depo-Provera]. No date. Available at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/020246s036lbl.pdf (accessed 7 March 2018).

7. Polis CB, Phillips SJ, Curtis KM. Hormonal contraception use and female-to-male HIV transmission: a systematic review of the epidemiologic evidence. AIDS 2012; 27: 493-505. Abstract available at: https://pubmed.ncbi.nlm.nih.gov/23079808/ (accessed 25 May 2022).