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Markers of increased HIV susceptibility in the setting of medroxyprogesterone and progesterone: A pilot study

Dominika Seidman, MD, University of California, San Francisco, 2015

Project abstract

Over 10 million women use injectable hormonal contraception and live in high HIV-prevalence areas. Recent meta-analyses suggest that depot medroxyprogesterone acetate (DMPA) increases women’s risk of HIV acquisition by 40-50%. Alternatives to DMPA in many regions of high HIV prevalence are limited, and withdrawal of DMPA would likely result in increased unintended pregnancies. Observational studies suggest a two-fold increased risk of HIV acquisition in pregnancy. The epidemiologic data regarding HIV susceptibility in the setting of DMPA and pregnancy are controversial and plagued by complex confounders.

Further research is urgently needed to determine the effects of high-progestin states on HIV susceptibility. We hypothesize that HIV susceptibility is greater in pregnant women and DMPA users than in non-pregnant/non-DMPA users and that these differences can be detected by ex vivo assays. We propose to employ two methods to evaluate cervical cells’ susceptibility to HIV from (1) DMPA users, (2) pregnant women, and (3) non-pregnant women not using hormonal contraceptives. First, we will perform immunophenotyping for HIV coreceptors and activation markers. Second, we will quantify the number of cells susceptible to HIV fusion.

This pilot study will allow us to assess ex vivo methods of measuring cervical cells’ HIV susceptibility and may reveal a correlation with systemic progestin levels. If informative, our study will drive future research addressing the link between HIV susceptibility and progestin-based contraceptives. Other potential outcomes may highlight the importance of including a pregnant comparison group in contraceptive and HIV research and encourage contraceptive method mix expansion in high HIV-prevalence areas.

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