The Influence of Hormonal Contraceptive Use on HIV-1 Transmission and Disease Progression

Women account for nearly one-half of new human immunodeficiency virus type 1 (HIV-1) infections worldwide, including the majority of infections in Africa. Biological and epidemiological studies suggest that hormonal contraceptive use could influence susceptibility to HIV-1, as well as infectivity and disease progression for those who become infected. However, not all studies have shown this relationship, and many questions remain. Safe and effective contraceptive choices are essential for women with and at risk for HIV-1 infection. Thus, understanding the effect, if any, of hormonal contraception on HIV-1 disease among women is a public health priority. Worldwide, 17.3 million women are infected with HIV-1 [1]. Heterosexual intercourse is responsible for most HIV-1 trans-missions to women, and the majority of infected women are of reproductive age. Hormonal forms of contraception, primarily oral contra-ceptive pills and the injectable depot medroxyprogesterone ac-etate (DMPA), are used by 1100 million women [2]. Hormonal contraceptives have physiological actions beyond pregnancy prevention—both beneficial health effects and risks of advers