Recent articles by Ralph et al. [
1
,
2
] and Gollub and Stein [
[3]
], as well as an accompanying commentary by Jones [
[4]
] in the current issue of Contraception, have challenged the concept of conducting a randomized trial to determine whether
injectable depot medroxyprogesterone acetate (DMPA) increases the risk of HIV acquisition.
They all raise concerns about the evidence, the methodology, the ethics, the feasibility
and the return on investment of such an undertaking. While those authors acknowledge
the uncertainty of the evidence regarding the effect of hormonal contraception, particularly
DMPA, on increased HIV risk, they argue that the observational data are of sufficiently
high quality to inform women of the potential risks and recommend against investing
in a randomized trial to answer the question.To read this article in full you will need to make a payment
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References
- Next steps for research on hormonal contraception and HIV.Lancet. 2013; 382: 1467-1469
- Research on hormonal contraception and HIV (reply).Lancet. 2014; 353: 305-306
- Research on hormonal contraception and HIV.Lancet. 2014; 383: 304-305
- Time to focus on improving the contraceptive method mix and let go of unanswerable questions.Contraception. 2014; 90: 357-359
- Hormonal contraception and HIV: technical statement.Research DoRHa, Geneva, Switzerland2012
- Hormonal contraceptive methods and risk of HIV acquisition in women: a systematic review of epidemiological evidence.Contraception. 2014; 90: 360-391
Gaffield M.E., Phillips S.J., Baggaley R.C., Steyn P., Temmerman M. HIV and contraception — complex issues for safe choice: the latest recommendations from the world health organization (WHO).
- Hormonal contraception and the risks of STI acquisition: results of a feasibility study to plan a future randomized trial.Contraception. 2008; 77: 366-370
- Randomized assignment to copper IUD or depot-medroxyprogesterone acetate: feasibility of enrollment, continuation, and disease ascertainment.Contraception. 2005; 72: 187-191
- A randomized trial of DMPA and the Cu-IUD.in: Presented at the WHO Expert Group to Examine Hormonal Contraception and HIV. Geneva: January 31,2012
- Effectiveness of longer-acting reversible contraception.N Engl J Med. 2012; 366: 1998-2007
Article info
Publication history
Accepted:
August 7,
2014
Received:
July 21,
2014
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
