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Biological effects, hormone levels and mechanisms relevant to HIV-1 infection for women randomized to the injectable contraceptives depo-medroxyprogesterone acetate or norethisterone enanthate.

Award Number: R01AI152118
ORGANIZATION: NATIONAL INSTITUTE OF ALLERGY & INFECTIOUS DISEASES
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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The proposed research seeks to understand plausible biological mechanisms whereby different injectable contraceptives may or may not affect susceptibility to infections such as HIV-1. High usage of injectable contraceptives correlates with high prevalence of HIV-1 infection in sub-Saharan Africa and South Africa. A strong gender bias for HIV-1 infection occurs towards young women in sub-Saharan Africa. Depo- medroxyprogesterone acetate (DMPA-IM), a three-monthly, intramuscular (IM) injection of 150 mg MPA is the most commonly used, while Norethisterone enanthate (NET-EN), a two-monthly, IM injection of 200 mg NET- EN is widely used in South Africa, especially among young women. Higher quality observational clinical data show a significant 40-50% increased risk of HIV-1 acquisition compared to no hormonal contraception for DMPA-IM. Limited observational studies found no significant increased risk for HIV-1 acquisition compared to no hormonal contraception for NET-EN, while two head-to-head comparisons found a potential 32-40% increase in HIV-1 risk for DMPA-IM versus NET-EN users. Recent results from the randomized ECHO trial do not inform on the risk of HIV-1 infection of DMPA-IM compared to NET-EN, or for DMPA-IM compared to no hormonal contraception. However, they do suggest progestin-specific effects with a best estimate of 23-29% increased risk for DMPA-IM compared to a levonorgestrel-containing implant over only 18 months. It is possible that a 32-40% difference in HIV-1 risk between DMPA-IM and NET-EN, taking into account both vertical and horizontal transmission, may have an important impact on the epidemic over a longer time period in high risk populations and may be highly relevant for individual women who desire informed choice. Given the potential for confounding factors in observational studies, a definitive answer as to the relative HIV-1 risks of DMPA-IM and NET-EN remains elusive. Another approach to gaining insights into the relative risks of DMPA- IM versus NET-EN is to obtain and evaluate high quality clinical biological data on responses strongly implicated in HIV-1 acquisition from women randomized to DMPA-IM and NET-EN. We will obtain archived samples from such a randomized trial (The WHICH (part 1) trial), and measure biomarkers of immune function and other potential markers of HIV-1 susceptibility. We will also perform a series of in vivo and ex vivo mechanistic studies to investigate plausible biological mechanisms for MPA and NET for HIV-1 acquisition and determine how those results correlate with the clinical data. The results will provide insight into whether and how DMPA-IM and NET-EN exert different biological effects, with implications for HIV-1 acquisition in women. The results will contribute significantly to scientific knowledge in the contraception and HIV-1 fields. They are likely to impact on clinical practice, health policy and international guidelines, to either reassure the interchangeable use or suggest preferential use of one of these injectable contraceptives over the other in populations at high risk of HIV-1 infection.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2024 ( Subtotal = $0 )
2024	2021	UNIVERSITY OF CAPE TOWN	LOVERS WALK	CAPE TOWN				ZAF	Allergy and Infectious Diseases Research	001	2	3/21/2024	NON-COMPETING CONTINUATION	$0
2024	2020	UNIVERSITY OF CAPE TOWN	LOVERS WALK	CAPE TOWN				ZAF	Allergy and Infectious Diseases Research	000	1	3/14/2024	NEW	$0
														Subtotal = $0

Issue Date FY: 2023 ( Subtotal = $629,850 )
2023	2023	UNIVERSITY OF CAPE TOWN	LOVERS WALK	CAPE TOWN				ZAF	Allergy and Infectious Diseases Research	001	4	3/27/2023	NON-COMPETING CONTINUATION	$343,748
2023	2023	UNIVERSITY OF CAPE TOWN	LOVERS WALK	CAPE TOWN				ZAF	Allergy and Infectious Diseases Research	002	4	7/26/2023	NON-COMPETING CONTINUATION	$286,102
2023	2022	UNIVERSITY OF CAPE TOWN	LOVERS WALK	CAPE TOWN				ZAF	Allergy and Infectious Diseases Research	000	3	3/22/2023	NON-COMPETING CONTINUATION	$0
														Subtotal = $629,850

Issue Date FY: 2022 ( Subtotal = $345,754 )
2022	2022	UNIVERSITY OF CAPE TOWN	LOVERS WALK	RONDEBOSCH				ZAF	Allergy and Infectious Diseases Research	000	3	4/27/2022	NON-COMPETING CONTINUATION	$345,754
														Subtotal = $345,754

Issue Date FY: 2021 ( Subtotal = $347,450 )
2021	2021	UNIVERSITY OF CAPE TOWN	LOVERS WALK	RONDEBOSCH				ZAF	Allergy and Infectious Diseases Research	000	2	4/23/2021	NON-COMPETING CONTINUATION	$347,450
														Subtotal = $347,450

Issue Date FY: 2020 ( Subtotal = $349,856 )
2020	2020	UNIVERSITY OF CAPE TOWN	LOVERS WALK	RONDEBOSCH		007700		ZAF	Allergy and Infectious Diseases Research	000	1	5/11/2020	NEW	$349,856
														Subtotal = $349,856

Grand Total All Awards = $1,672,910

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Biological effects, hormone levels and mechanisms relevant to HIV-1 infection for women randomized to the injectable contraceptives depo-medroxyprogesterone acetate or norethisterone enanthate.

Award Number: R01AI152118

ORGANIZATION: NATIONAL INSTITUTE OF ALLERGY & INFECTIOUS DISEASES

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

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