Update on the Impact of Depot Medroxyprogesterone Acetate on Vaginal Mucosal Endpoints and Relevance to Sexually Transmitted Infections.
Depot medroxyprogesterone acetate
ECHO Trial
Epithelial barrier
Immune cells
Inflammation
Vaginal microbiome
Journal
Current HIV/AIDS reports
ISSN: 1548-3576
Titre abrégé: Curr HIV/AIDS Rep
Pays: United States
ID NLM: 101235661
Informations de publication
Date de publication:
08 2023
08 2023
Historique:
accepted:
29
05
2023
medline:
7
8
2023
pubmed:
21
6
2023
entrez:
21
6
2023
Statut:
ppublish
Résumé
The long-acting reversible intramuscularly-injected contraceptive depot medroxyprogesterone acetate (DMPA-IM) is widely used by cisgender women in Africa. Although DMPA-IM provides reliable contraception, potential effects on the female genital tract (FGT) mucosa have raised concern, including risk of HIV infection. This review summarises and compares evidence from observational cohort studies and the randomised Evidence for Contraceptive Options in HIV Outcomes (ECHO) Trial. Although previous observational studies found women using DMPA-IM had higher abundance of bacterial vaginosis (BV)-associated bacteria, increased inflammation, increased cervicovaginal HIV target cell density, and epithelial barrier damage, sub-studies of the ECHO Trial found no adverse changes in vaginal microbiome, inflammation, proteome, transcriptome, and risk of viral and bacterial STIs, other than an increase in Th17-like cells. Randomised data suggest that DMPA-IM use does not adversely change mucosal endpoints associated with acquisition of infections. These findings support the safe use of DMPA-IM in women at high risk of acquiring STIs, including HIV.
Identifiants
pubmed: 37341916
doi: 10.1007/s11904-023-00662-0
pii: 10.1007/s11904-023-00662-0
pmc: PMC10403392
doi:
Substances chimiques
Medroxyprogesterone Acetate
C2QI4IOI2G
Contraceptive Agents, Female
0
Types de publication
Journal Article
Review
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
251-260Subventions
Organisme : NICHD NIH HHS
ID : R01 HD089831
Pays : United States
Organisme : NIMH NIH HHS
ID : K24 MH123371
Pays : United States
Informations de copyright
© 2023. The Author(s).
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