Impact of Hormonal Contraception on HIV Acquisition and Transmission Risk

Impact of Hormonal Contraception on HIV Acquisition and Transmission Risk

This is a prospective cohort study focusing on HIV negative women. The investigators want to learn how the contraceptive methods of depot medroxyprogesterone acetate (DMPA), etonogestrel implant (Eng-Implant), levonorgestrel intrauterine device (Lng-IUD) and the ParaGard® T 380A Intrauterine Copper Contraceptive impact the vaginal immune environment.

The three proposed aims will evaluate the effect of four contraceptive methods (depot medroxyprogesterone acetate (DMPA), etonogestrel implant (Eng-Implant), levonorgestrel intrauterine device (Lng-IUD) and ParaGard® T 380A Intrauterine Copper Contraceptive) on: (1) HIV target immune cells within the female genital mucosa; (2) markers of T-cell activation and trafficking within the female genital mucosa; and (3) secreted cytokines and chemokines within the female genital mucosa.

Inclusion Criteria:

• Female
• Age 18-45 years
• Normal menses (22-35 day intervals) for at least 3 cycles
• Intact uterus and cervix
• Interested in to DMPA, Eng-Implant or Lng-IUD or ParaGuard
• Willing to delay initiation of hormonal contraception for up to 1 month
• Willing to use condoms or abstain from sexual intercourse for at least 48 hours before each genital tract sampling (condoms will be made available)
• Able and willing to provide informed consent, and undergo serial blood and cervicovaginal lavage (CVL) sampling
• Negative HIV screening

Exclusion Criteria:

• Pregnant within the last 3 months
• Breastfeeding
• History of loop electrosurgical excision procedure, conization, or cryosurgery within the past year
• Use of hormonal contraception or IUD in the past 6 months
• Known history of medical condition that would interfere with the conduct of the study
• Symptomatic vaginal infection or genital ulcer disease at screening
• Taking medications that interact with selected contraceptive
• Contraindications to selected contraceptive per the Centers for Disease Control and Prevention (CDC) medical eligibility criteria or judgment of clinician