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passages: document
passages: Use of hormonal contraceptives and risk of HIV-1 transmission : a prospective cohort study . BACKGROUND Hormonal contraceptives are used widely but their effects on HIV-1 risk are unclear . We aimed to assess the association between hormonal contraceptive use and risk of HIV-1 acquisition by women and HIV-1 transmission from HIV-1-infected women to their male partners . METHODS In this prospective study , we followed up 3790 heterosexual HIV-1-serodiscordant couples participating in two longitudinal studies of HIV-1 incidence in seven African countries . Among injectable and oral hormonal contraceptive users and non-users , we compared rates of HIV-1 acquisition by women and HIV-1 transmission from women to men . The primary outcome measure was HIV-1 seroconversion . We used Cox proportional hazards regression and marginal structural modelling to assess the effect of contraceptive use on HIV-1 risk . FINDINGS Among 1314 couples in which the HIV-1-seronegative partner was female ( median follow-up 18·0 [ IQR 12·6-24·2 ] months ) , rates of HIV-1 acquisition were 6·61 per 100 person-years in women who used hormonal contraception and 3·78 per 100 person-years in those who did not ( adjusted hazard ratio 1·98 , 95 % CI 1·06-3·68 , p=0·03 ) . Among 2476 couples in which the HIV-1-seronegative partner was male ( median follow-up 18·7 [ IQR 12·8-24·2 ] months ) , rates of HIV-1 transmission from women to men were 2·61 per 100 person-years in couples in which women used hormonal contraception and 1·51 per 100 person-years in couples in which women did not use hormonal contraception ( adjusted hazard ratio 1·97 , 95 % CI 1·12-3·45 , p=0·02 ) . Marginal structural model analyses generated much the same results to the Cox proportional hazards regression . INTERPRETATION Women should be counselled about potentially increased risk of HIV-1 acquisition and transmission with hormonal contraception , especially injectable methods , and about the importance of dual protection with condoms to decrease HIV-1 risk . Non-hormonal or low-dose hormonal contraceptive methods should be considered for women with or at-risk for HIV-1 . FUNDING US National Institutes of Health and the Bill & Melinda Gates Foundation .
entities: 2255
entities: Intervention_Pharmacological
entities: hormonal contraceptives
entities: 2256
entities: Intervention_Pharmacological
entities: Hormonal contraceptives
entities: 2257
entities: Intervention_Pharmacological
entities: hormonal contraceptive
entities: 2258
entities: Intervention_Pharmacological
entities: hormonal contraceptive
entities: 2259
entities: Outcome_Physical
entities: HIV-1 acquisition
entities: 2260
entities: Outcome_Physical
entities: HIV-1 transmission
entities: 2261
entities: Outcome_Physical
entities: risk of HIV-1 acquisition
entities: 2262
entities: Participant_Sample-size
entities: 3790
entities: 2263
entities: Participant_Condition
entities: heterosexual HIV-1-serodiscordant couples participating in two longitudinal studies of HIV-1 incidence in seven African countries
entities: 2264
entities: Participant_Sample-size
entities: 1314
entities: 2265
entities: Participant_Condition
entities: couples in which the HIV-1-seronegative partner
entities: 2266
entities: Participant_Sex
entities: female