Contraceptive Hormones, Immunity, and Microbiome Evaluation

NCT ID: NCT03660046

Last Updated: 2024-10-29

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

155 participants

Study Classification

OBSERVATIONAL

Study Start Date

2018-12-07

Study Completion Date

2023-09-07

Brief Summary

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The study is a prospective cohort study to explore the mechanisms underlying the HIV risk associated with pharmacologic doses of exogenous sex hormones via hormonal contraceptives specially progestin-containing hormonal contraception (HC). The study seeks to test that HC induce immunologic changes capable of altering HIV susceptibilities, that these effects will vary by contraceptive type, and that they will be modified by the vaginal microenvironment.

Detailed Description

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This study is a translational research project to explore the mechanisms underlying the HIV risk associated with pharmacologic doses of exogenous sex hormones (via hormonal contraceptives). Emerging data suggests that certain hormonal contraceptives may induce mucosal and systemic immune changes that could increase the risk of infection with HIV. While several studies have aimed to characterize immunologic changes in women using hormonal contraceptives, the nature and the magnitude of these immune changes have not been adequately defined due to limitations in study design rigor, and small and statistically underpowered sample sizes.

The study will prospectively recruit cohorts of HIV-uninfected women initiating hormonal contraception to characterize systemic and lower genital tract innate and adaptive immunologic changes that occur over a course of up to 4 months. This study will test the overarching hypothesis that hormonal contraceptives induce systemic and mucosal immune changes capable of altering susceptibilities and/or responses to diseases including HIV infection, and that these effects vary markedly in nature and magnitude by contraceptive type and will be modified by the vaginal microenvironment. The main aim is to determine the immunologic alterations in female genital and systemic immune profile associated with depot medroxyprogesterone acetate (DMPA), Etonogestrel implant (Eng-Implant) and Levonorgestrel IUD (Lng-IUD).

Conditions

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Hormonal Contraception

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Depot medroxyprogesterone acetate (DMPA)

This arm includes subjects that choose Depot medroxyprogesterone acetate (DMPA) as contraception.

Depot medroxyprogesterone acetate (DMPA)

Intervention Type DRUG

Depot medroxyprogesterone acetate (DMPA) will be dispensed from the Grady Pharmacy Service and will be administered every 12 weeks at the standard dose of 150 mg Intramuscular injection, beginning from week 3 of study enrollment and repeated every 13 weeks

Etonogestrel implant (Eng-Implant)

This arm includes subjects that choose Etonogestrel implant (Eng-Implant) as contraception.

Etonogestrel implant (Eng-Implant)

Intervention Type DRUG

A standard Nexplanon rod Implant that is a subdermal implant in the arm. This will be placed at study week 3 by Dr. Haddad or a trained clinician. It contains Etonogestrel 68mg.

Levonorgestrel IUD (Lng-IUD)

This arm includes subjects that choose Levonorgestrel Intrauterine device (Lng-IUD) as contraception.

Levonorgestrel IUD (Lng-IUD)

Intervention Type DRUG

The Levonorgestrel Intrauterine Device (Lng-IUD) (Mirena or copper) will be placed at study week 3 by Dr. Haddad or a trained clinician.

Interventions

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Depot medroxyprogesterone acetate (DMPA)

Depot medroxyprogesterone acetate (DMPA) will be dispensed from the Grady Pharmacy Service and will be administered every 12 weeks at the standard dose of 150 mg Intramuscular injection, beginning from week 3 of study enrollment and repeated every 13 weeks

Intervention Type DRUG

Etonogestrel implant (Eng-Implant)

A standard Nexplanon rod Implant that is a subdermal implant in the arm. This will be placed at study week 3 by Dr. Haddad or a trained clinician. It contains Etonogestrel 68mg.

Intervention Type DRUG

Levonorgestrel IUD (Lng-IUD)

The Levonorgestrel Intrauterine Device (Lng-IUD) (Mirena or copper) will be placed at study week 3 by Dr. Haddad or a trained clinician.

Intervention Type DRUG

Other Intervention Names

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Medroxyprogesterone acetate (MPA) Depo-Provera Nexplanon Mirena Copper

Eligibility Criteria

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Inclusion Criteria

* Female sex, defined by sex at birth.
* Age ≤ 45 years. If \< 18 years of age, participant must be capable of providing assent, understanding and complying with all study procedures, and have written informed consent from a parent or legal guardian.
* Normal menses (occurring within 22-35 day intervals) for \> 2 cycles. Women who are postpartum or post-abortion who have resumed menses are eligible.
* Intact uterus and cervix.
* Interested in initiating HC and willing to accept DMPA, Eng-Implant or Lng-IUD.
* Willing to delay initiation of HC for up to 1 month.
* Able and willing to provide informed consent, and undergo study procedures.
* Negative HIV test by Ora-Quick© method at Screening Visit.
* Agree to abstain from vaginal intercourse or using intra-vaginal products for 1 day prior to each study visit.

Exclusion Criteria

* Pregnant or planning to become pregnant within the next year.
* Breastfeeding, if not having active menstrual cycles. Breastfeeding is not exclusionary if the participant is actively cycling.
* History of loop electrosurgical excision procedure (LEEP), conization, or cryosurgery within the past year.
* Current use of systemic HC or IUD, based on self-report and/or hormonal testing.
* Taking concurrent medications that interact with selected HC.
* Contraindications to selected contraceptive per the Center for Disease Control medical eligibility criteria or judgment of clinician.
* Allergy to lidocaine for cervical biopsies (if consenting to optional biopsies).
Maximum Eligible Age

45 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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National Institutes of Health (NIH)

NIH

Sponsor Role collaborator

Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD)

NIH

Sponsor Role collaborator

Emory University

OTHER

Sponsor Role lead

Responsible Party

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Alicia K Smith

Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Alicia Smith, PhD

Role: PRINCIPAL_INVESTIGATOR

Emory University

Locations

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Grady Health System

Atlanta, Georgia, United States

Site Status

The Emory Clinic, Bldg A., 2nd Floor, 1365 Clifton Road, NE

Atlanta, Georgia, United States

Site Status

Atlanta Women's Center

Atlanta, Georgia, United States

Site Status

Countries

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United States

Other Identifiers

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R01HD095741-01A1

Identifier Type: NIH

Identifier Source: secondary_id

View Link

IRB00104017

Identifier Type: -

Identifier Source: org_study_id

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