Research gaps in defining the biological link between HIV risk and hormonal contraception.
Research gaps in defining the biological link between HIV risk and hormonal contraception.
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DOI：
10.1111/aji.12209
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发表时间：
2014-08
期刊：
影响因子：
--
通讯作者：
Herold BC
中科院分区：
文献类型：
--
作者：
Murphy K;Irvin SC;Herold BC
流行病学数据显示，醋酸甲羟孕酮（DMPA）是一种以孕酮为基础的激素避孕药，与艾滋病毒感染和传播风险增加有关。DMPA非常有效，是艾滋病毒高流行地区最常用的激素避孕形式之一。因此，确定导致DMPA和HIV之间潜在负协同作用的生物学机制是关键，并可能有助于确定替代避孕策略。提出的机制包括宫颈阴道上皮屏障变薄或破坏，粘膜炎症的诱导，先天和适应性可溶性和细胞免疫反应的干扰，和/或阴道微生物群的改变。DMPA还可能通过促进生殖器疱疹或其他性传播感染间接增加感染艾滋病毒的风险。然而，缺乏严格的体外、动物模型和临床数据来支持这些潜在的机制，这突出了未来研究的必要性。
Epidemiologic data suggest an association between depot medroxyprogesterone acetate (DMPA), a progesterone-based hormonal contraceptive, and increased risk of HIV acquisition and transmission. DMPA is highly effective and is among the most commonly used form of hormonal contraception in areas of high HIV prevalence. Thus, defining the biological mechanisms that contribute to the potential negative synergy between DMPA and HIV is key and may facilitate the identification of alternative contraceptive strategies. Proposed mechanisms include thinning or disruption of the cervicovaginal epithelial barrier, induction of mucosal inflammation, interference with innate and adaptive soluble and cellular immune responses, and/or alterations in the vaginal microbiome. DMPA may also indirectly increase the risk of HIV by promoting genital herpes or other sexually transmitted infections. However, there is a paucity of rigorous in vitro, animal model and clinical data to support these potential mechanisms highlighting the need for future research.
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