Friday, December 16, 2011

Helpful Hormones: The potential benefits of hormonal contraceptives on delaying HIV progression to AIDS

Any person who has sat through “sex-ed” has heard about practicing safe sex, using condoms to prevent the transfer of STDs from one partner to another. Additionally, there are other methods of contraceptives, namely hormonal contraceptives. Once one has contracted HIV there is an even increased necessity to protect against pregnancy in order to prevent transmission of disease to the child and to protect the mother against unwanted pregnancy. However, with hormone treatments there have been studies that indicated the hormonal contraceptives actually advance the progression of HIV in patients.1 While this has mainly been documented in undeveloped countries, any implication in the advancement of HIV towards AIDS is a concern and should be studied.
Some of the largest populations of HIV positive persons are the commercial sex workers and the populations in sub-Saharan Africa.2 One study in particular followed a group of HIV seroconverted women located in Uganda for a person of 11 years. This was one of the most extensive studies with one of the largest sample sizes, thus increasing the possibility for significant results (625 women in study). The women in this study were compared for differences between the hormonal contraceptive users and nonusers and monitored for the change from HIV to AIDS or death. Hormonal contraceptives in this study were considered both oral contraceptive pills and implanted hormonal contraceptives.
In the entire study 27% of participants used hormonal contraception at some point during the study. What the researchers found was that, in general, women who reported using hormonal contraceptives had a longer delay to onset of AIDS and a longer time until death. Specifically, those who used hormonal contraception had on average 3.92 years until death, and 3.72 years until AIDS, compared to 3.04 years until death and 2.98 years until AIDS or those without hormonal contraceptive use. Interestingly, this study also took note as to what kind of behavioral patterns the hormonal contraceptive users engaged in compared to the nonusers. This study found that women using hormonal contraceptives had on average a higher degree of education, were in the median age category (25-35), and were also less likely to use condoms. These have to be taken into account as well as the hormonal contraceptive use as possible variables affecting onset of AIDS and death.
While there have been studies that have linked hormonal contraceptives with an increase in time to onset of AIDS, the results of this study are not unheard of. Some previous studies have suggested that the hormonal contraceptives may actually reduce HIV progression.3 This study was also quick to point out their strengths, namely that their study provides evidence that hormonal contraceptives do not have an impact on the progression of HIV to AIDS/death. However, there were also limitations that this study had to deal with and should be pointed out in this discussion. In particular, it was very difficult to determine a death as AIDS related as opposed to outside causes. Another problem with this study was the difficulty in determining the varying affects that differing hormonal contraceptives had on varying the degrees of HIV progression.
The big picture to take away from this study is the vast array of treatments and possible drug therapies that can be applied to HIV/AIDS patients. There are large groups of people worldwide who are HIV seroconverters that are being observed and studied in order to advance preventive technologies. It is important that all possible treatments are considered as there has yet to be an effective vaccine developed. While the specific biological interactions were not considered in this study, there is still a future direction in hormone treatment, and anything that can slow the onset of AIDS is worth a second look.
Primary Resource
Polis C, Wawer M, Kiwanuka N, Laeyendecker O, Kagaayi J, Lutalo T, Nalugoda F, Kigozi G, Serwadda D, and Gray R. (2010). Effect of hormonal contraceptive use on HIV progression in female HIV seroconverters in Rakai, Uganda. AIDS. 24:1937-1944. Doi: 10.1097/QAD.0b013e32833b3282
Additional Resources
1. Stringer EM, Kaseba C Levy J, Sinkala M, Goldenber RL, Chi BH, et al. (2007) A randomized trial of the intrauterine contraceptive device vs hormonal contraception in women who are infected with the human immunodeficiency virus. Am J Obstet Gynecol 197: 144-148
2. “UNAIDS: Sub-Saharan Africa” WHO. 2009 091124_fs_ssa_en.pdf>
3. Allen S, Stephenson R, Weiss H, Karita E, Priddy R, Fuller L, et a. (2007) Pregnancy, hormonal contraceptive use, and HIV-related death in Rwanda. J Womens Health. 15:1017-1027

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