Preexposure prophylaxis is efficacious for HIV-1 prevention among women using depot medroxyprogesterone acetate for contraception

Renee Heffron, Nelly Mugo, Edwin Were, James Kiarie, Elizabeth A. Bukusi, Andrew Mujugira, Lisa M. Frenkel, Deborah Donnell, Allan Ronald, Connie Celum, Jared M. Baeten, L. F. Robert, Uganda Kabwohe, Uganda Jinja, Craig W. Hendrix, Jairam Lingappa, M. Juliana McElrath, Eldoret Kenya, Kenneth Fife, Elioda TumwesigyeUganda Kampala, A. R. Elly Katabira, Kenya Kisumu, Uganda Mbale, Kenya Nairobi, Patrick Ndase, Elly Katabira, Craig Cohen, Jonathan Wangisi, James Campbell, Jordan Tappero, Kenya Thika, Uganda Tororo, Carey Farquhar, Grace John-Stewart, Nelly Rwamba Mugo

Research output: Contribution to journalArticle

Abstract

Objective: To evaluate preexposure prophylaxis (PrEP) efficacy for HIV-1 prevention among women using depot medroxyprogesterone acetate (DMPA) for contraception and men whose HIV-1-infected partners use DMPA. Design: Secondary analysis of data from a randomized placebo-controlled trial of daily oral tenofovir and emtricitabine/tenofovir PrEP among heterosexual Kenyan and Ugandan HIV-1 serodiscordant couples. Methods: PrEP efficacy for HIV-1 prevention was compared among HIV-1-uninfected women using DMPA versus no hormonal contraception and among HIV-1 uninfected men whose HIV-1-infected female partners used DMPA versus no hormonal contraception. Results: Of 4747 HIV-1 serodiscordant couples, 901 HIV-1-uninfected women used DMPA at some point during follow-up, 1422 HIV-1-uninfected women used no hormonal contraception, 1568 HIV-1-uninfected men had female partners who used DMPA, and 2626 men had female partners who used no hormonal contraception. PrEP efficacy estimates for HIV-1 prevention, compared with placebo, were similar among women using DMPA and those using no hormonal contraception (64.7 and 75.5%, adjusted interaction P=0.65). Similarly, for men whose female partners used DMPA, PrEP efficacy did not differ from men whose partners used no hormonal contraception (90.0 versus 81.7%, adjusted interaction P=0.52). Conclusion: PrEP is efficacious for HIV-1 prevention among women using DMPA and men whose partners use DMPA, suggesting PrEP could mitigate the potential increased HIV-1 acquisition and transmission risks that have been associated with DMPA use. Women at risk for HIV-1 choosing DMPA could maintain this contraceptive method and add PrEP to achieve prevention of unintended pregnancy and HIV-1.

Original languageEnglish (US)
Pages (from-to)2771-2776
Number of pages6
JournalAIDS
Volume28
Issue number18
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Keywords

  • Depot medroxyprogesterone acetate
  • HIV-1 prevention
  • Hormonal contraception
  • Preexposure prophylaxis efficacy

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

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    Heffron, R., Mugo, N., Were, E., Kiarie, J., Bukusi, E. A., Mujugira, A., Frenkel, L. M., Donnell, D., Ronald, A., Celum, C., Baeten, J. M., Robert, L. F., Kabwohe, U., Jinja, U., Hendrix, C. W., Lingappa, J., McElrath, M. J., Kenya, E., Fife, K., ... Mugo, N. R. (2014). Preexposure prophylaxis is efficacious for HIV-1 prevention among women using depot medroxyprogesterone acetate for contraception. AIDS, 28(18), 2771-2776. https://doi.org/10.1097/QAD.0000000000000493