Impact of Different Contraceptives on the Immune System of HIV Infected Women in Zambia

In this randomized controlled trial, 66 HIV-infected women who desire contraception will be assigned to one of two treatment groups: IUD or Depo Provera. The study builds on findings from a previous study which examined the safety and acceptability of hormonal contraception and IUD among HIV-infected women. Secondary analyses from the previous study indicated that women who were assigned to the hormonal arm appeared to have faster disease progression based on death and decline in CD4+ count as compared to women assigned to the IUD arm. With the current study, investigators seek to understand potential mechanisms for the effect of hormonal contraception on hastening HIV disease progression. Enrolled women will be asked to use the assigned contraception method for a period of six months, and various indicators of disease progression will be collected at four follow-up visits after randomization.

Inclusion criteria

• Confirmed HIV status by local rapid test algorithm
• Willingness to be randomized to a contraceptive method and continue that method for at least 6 months.
• Intention to stay in the study area for at least 6 months

Exclusion criteria

• Currently pregnant or pregnant within the prior 6 months
• Currently breastfeeding
• Documented liver disease
• History of coagulation disorder
• Active tuberculosis
• Anemia, defined as Hgb <8gm/dL
• Age < 16 years (the age of consent in Zambia);
• Eligible for antiretroviral therapy based on Zambian National Guidelines (CD4+ < 200, or WHO stage IV, or CD4+< 350 and WHO stage III)
• Currently using an IUD or hormonal method of contraception, or have used a hormonal contraceptive in the past 6 months