Depot medroxyprogesterone acetate (DMPA) enhances susceptibility and increases the window of vulnerability to HIV-1 in humanized mice

Sci Rep. 2021 Feb 16;11(1):3894. doi: 10.1038/s41598-021-83242-9.

Abstract

The progestin-based hormonal contraceptive Depot Medroxyprogesterone Acetate (DMPA) is widely used in sub-Saharan Africa, where HIV-1 is endemic. Meta-analyses have shown that women using DMPA are 40% more likely than women not using hormonal contraceptives to acquire Human Immunodeficiency Virus (HIV-1). Therefore understanding how DMPA increases susceptibility to HIV-1 is an important public health issue. Using C57BL/6 mice and our previously optimized humanized mouse model (NOD-Rag1tm1Mom Il2rgtm1Wjl transplanted with hCD34-enriched hematopoietic stem cells; Hu-mice) where peripheral blood and tissues are reconstituted by human immune cells, we assessed how DMPA affected mucosal barrier function, HIV-1 susceptibility, viral titres, and target cells compared to mice in the diestrus phase of the estrous cycle, when endogenous progesterone is highest. We found that DMPA enhanced FITC-dextran dye leakage from the vaginal tract into the systemic circulation, enhanced target cells (hCD68+ macrophages, hCD4+ T cells) in the vaginal tract and peripheral blood (hCD45+hCD3+hCD4+hCCR5+ T cells), increased the rate of intravaginal HIV-1 infection, extended the window of vulnerability, and lowered vaginal viral titres following infection. These findings suggest DMPA may enhance susceptibility to HIV-1 in Hu-mice by impairing the vaginal epithelial barrier, increasing vaginal target cells (including macrophages), and extending the period of time during which Hu-mice are susceptible to infection; mechanisms that might also affect HIV-1 susceptibility in women.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Animals
  • Contraceptive Agents, Hormonal / adverse effects*
  • Cytokines / metabolism
  • Delayed-Action Preparations
  • Disease Susceptibility / chemically induced
  • Female
  • HIV-1*
  • Host-Pathogen Interactions / drug effects*
  • Humans
  • Infant, Newborn
  • Macrophages
  • Medroxyprogesterone Acetate / adverse effects*
  • Mice
  • Mice, Inbred C57BL
  • Vagina / drug effects*
  • Vagina / immunology
  • Vagina / metabolism
  • Vagina / virology

Substances

  • Contraceptive Agents, Hormonal
  • Cytokines
  • Delayed-Action Preparations
  • Medroxyprogesterone Acetate