By Sinothando Siyolo
This article is exclusive to the Online Edition 4 of VARSITY News.
Across South Africa, women use a variety of contraceptives to prevent pregnancy, ranging from pills to implants to injectable contraceptives. Last April, the University of Cape Town released a breakthrough study showing that one of South Africa’s most commonly-used injectable contraceptives – a treatment known as Depo-Provera – could potentially increase a woman’s chance of contracting tuberculosis.
Depo-Provera is an injectable shot that prevents pregnancy. One of its main advantages is that the women who use it only need to take it once every three months, this has led it to become a preferred choice for many South Africans. This injection releases the hormone progestogen into the bloodstream to prevent pregnancy.
Recently, however, Professor Keertan Dheda and Dr. Michele Tomasicchio of the University of Cape Town used a meta-analysis of clinical observational data, which suggested that Depo-Provera may increase a woman’s chances of contracting tuberculosis. This is on the grounds that the injection contains the synthetic hormone medroxyprogesterone acetate (MPA), which acts as an immunosuppressant, meaning that it down-regulates immune functions that are associated with protection against TB.
“We found that the ability of human cells to kill TB was subverted by Depo-Provera,” Dheda said. ”These are findings generated in the laboratory, [so] whether this will translate into increased risk of tuberculosis in humans in the ‘real world’ remains to be seen.”
Depo-Provera is used in most South African clinics and women choose to use injectables as contraceptives 25 percent of the time, making this research highly relevant to many South Africans. Although the study did not conclude that the treatment will definitely increase the risk of tuberculosis in actual patients, research is continuing to better understand its risks.
Dheda said that the causal link will be established by a large randomized control trial, whose findings will be published later this year.
“The ECHO study results, which will be released later this year, will tell us definitively about this risk,” Dheda said. “Further data about TB will also emerge, but our findings raise concern.”
The government does not plan to ban the contraceptive, but those using the treatment should be aware of its potential risks, Dheda said.
Depo-Provera also has ties to HIV infections. Previous meta-analyses found that the treatments may cause up to a 40 percent increase in HIV risk in women.
“Be aware that there might be a potential risk between using Depo-Provera and an increased risk of acquiring HIV co-infection,” Dheda said. ”However, also be aware that this is an association and a causal link has not yet been proven. Thus, practice safe sex, use barrier methods of contraception to prevent acquiring HIV, and get yourself tested if appropriate.”
Dheda also recommended that young girls stay aware of the symptoms of tuberculosis, quit smoking, reduce alcohol use and take measures to prevent acquiring HIV infection.