Use of contraceptive depot medroxyprogesterone acetate is associated with impaired cervicovaginal mucosal integrity

J Clin Invest. 2018 Oct 1;128(10):4622-4638. doi: 10.1172/JCI120583. Epub 2018 Sep 17.


Background: Injectable depot medroxyprogesterone acetate (DMPA) is one of the most popular contraception methods in areas of high HIV seroprevalence. Evidence is accumulating that use of DMPA might be associated with an increased risk of HIV-1 acquisition by women; however, mechanisms of this association are not completely understood. The goal of this study was to gain insight into mechanisms underlying the possible link between use of DMPA and risk of HIV-1 acquisition, exploring transcription profiling of ectocervical tissues.

Methods: Healthy women received either DMPA (n = 31) or combined oral contraceptive (COC), which has not been linked to an increased risk of HIV acquisition (n = 32). We conducted a comparative microarray-based whole-genome transcriptome profiling of human ectocervical tissues before and after 6 weeks of hormonal contraception use.

Results: The analysis identified that expression of 235 and 76 genes was significantly altered after DMPA and COC use, respectively. The most striking effect of DMPA, but not COC, was significantly altered expression (mostly downregulation) of many genes strategically involved in the maintenance of mucosal barrier function; the alterations, as indicated by Ingenuity Pathway Analysis (IPA), were most likely due to the DMPA-induced estrogen deficiency. Furthermore, IPA predicted that transcriptome alterations related to ectocervical immune responses were in general compatible with an immunosuppressive effect of DMPA, but, in some women, also with an inflammatory-like response.

Conclusion: Our results suggest that impairment of cervicovaginal mucosal integrity in response to DMPA administration is an important mechanism contributing to the potential increased risk of HIV-1 acquisition in DMPA users.

Trial registration: NCT01421368.

Funding: This study was supported by the United States Agency for International Development (USAID) under Cooperative Agreement GPO-A-00-08-00005-00.

Keywords: AIDS/HIV; Expression profiling; Innate immunity; Reproductive Biology; Sex hormones.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Cervix Uteri / immunology*
  • Cervix Uteri / pathology
  • Cervix Uteri / virology
  • Contraceptive Agents, Female / administration & dosage
  • Contraceptive Agents, Female / adverse effects*
  • Female
  • HIV Infections / epidemiology
  • HIV Infections / immunology
  • HIV-1 / immunology
  • Humans
  • Immunity, Mucosal / drug effects*
  • Medroxyprogesterone Acetate / administration & dosage
  • Medroxyprogesterone Acetate / adverse effects*
  • Middle Aged
  • Mucous Membrane / immunology
  • Mucous Membrane / pathology
  • Prospective Studies
  • Seroepidemiologic Studies
  • Vagina / immunology*
  • Vagina / pathology
  • Vagina / virology


  • Contraceptive Agents, Female
  • Medroxyprogesterone Acetate

Associated data