Oral and Injectable Contraceptives and Increased Risk of HIV Infection

February 27, 2002, at the 9th Annual Retrovirus Conference in Seattle, Washington, U.S.A., researchers reported that "In a study of 115 female commercial sex workers with HIV, those who were on hormonal contraceptives primarily birth control pills or injectable progesterone at the time of infection had a five- to seven-fold higher risk of becoming infected with multiple strains of the virus than those not on hormones." One author of the study suggested this may be due to "birth control pills [causing] thinning of the vaginal lining," while another author says it may be "the hormones may change the cell population in the genital tract, possibly increasing the number of cells that are targets for HIV."

Another hypothesis, directly tied to known effects of the estrogenic components of oral contraceptives, ethinyl estradiol and mestranol, as well as "injectable progesterone," may explain the report. In 1985, I first connected low levels of the adrenal androgen, dehydroepiandrosterone (DHEA), with AIDS. It is my hypothesis that DHEA optimizes transcription and replication of DNA, therefore, all tissues are negatively affected by low DHEA. I suggest low DHEA results in reduced immune response to HIV infection and that the symptoms of AIDS actually represent further loss of DHEA during disease progression. Here is the new material:

A study of "oral contraceptives" found a significant decrease in DHEA in all groups using different oral contraceptives (Contraception 1996; 53: 171-6). Ethinyl estradiol, predominantly, and mestranol, secondarily, are the estrogenic components of various mono-, bi-, and triphasic, combination oral contraceptives. Ethinyl estradiol in oral contraceptives reduces DHEA (Contraception 1998; 58: 75-81 and Eur J Endocrinol 1999; 141:579-84) as does mestranol (Obstet Gynecol 1984; 63: 12-4). This reduction in DHEA is attributed to reduced production of DHEA by the adrenal glands, not the ovaries which are a source of smaller amounts of DHEA (Am J Obstet Gynecol 1978; 132: 380-4). Noristerat and depo-provera (medroxyprogesterone) are the two injectable progesterone contraceptives. There is no research regarding the effects of noristerat on DHEA. However, in women using depo-provera as a contraceptive, DHEA was significantly reduced (Contraception 1986; 33: 503-17).

In animal models, DHEA protects against a number of deadly viruses, including West Nile, Sindbis, and Semliki Forest viruses (Arch Virol 1991; 120: 263). I suggest that low DHEA increases vulnerability to HIV infection. The fact that oral and injectable contraceptives reduce DHEA may be the reason that contraceptive use increases the probability of HIV infection.

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