Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study.
Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study.
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DOI：
10.1016/s1473-3099(11)70247-x
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发表时间：
2012-01
影响因子：
56.3
通讯作者：
Baeten, Jared M.
中科院分区：
文献类型：
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作者：
Heffron, Renee;Donnell, Deborah;Rees, Helen;Celum, Connie;Mugo, Nelly;Were, Edwin;de Bruyn, Guy;Nakku-Joloba, Edith;Ngure, Kenneth;Kiarie, James;Coombs, Robert W.;Baeten, Jared M.
激素避孕药被广泛使用，但其对 HIV-1 风险的影响尚不清楚。我们跟踪了来自 7 个非洲国家的 3790 名 HIV-1 血清不一致的异性夫妇，参与了两项纵向 HIV-1 发病率研究。在激素避孕药使用者（包括注射和口服避孕药使用者）和非使用者中，我们比较了女性 HIV-1 感染率和 HIV-1 从女性向男性的传播率。在 1314 对 HIV-1 血清阴性伴侣为女性的夫妇中，激素避孕药使用者和非使用者的 HIV-1 获得率分别为每 100 人年 6.61 例和 3.78 例（调整后风险比 [AHR]=1.98，95% 置信区间 [CI] 1.06-3.68，p=0.03）。在 2476 对 HIV-1 血清阴性伴侣为男性的夫妇中，当前使用激素避孕药的伴侣与未使用激素避孕药的伴侣相比，从女性到男性的 HIV-1 传播率分别为每 100 人年 2.61 例和 1.51 例（AHR=1.97，95% CI 1.12-3.45，p=0.02）。在亚组分析中，注射避孕药使用者感染 HIV-1 并将其传播给其伴侣的风险增加，而使用注射避孕药的 HIV-1 血清阳性女性的生殖器 HIV-1 RNA 浓度较高，这表明存在传播风险增加的机制。口服避孕药的使用频率太低，无法得出有关 HIV-1 风险的明确结论。应告知妇女，激素避孕（尤其是注射避孕方法）可能会增加 HIV-1 感染和传播的风险，并告知妇女使用安全套进行双重保护对于降低 HIV-1 风险的重要性。对于感染 HIV-1 或有感染 HIV-1 风险的女性，应考虑采用非激素或低剂量激素避孕方法。美国国立卫生研究院（R03 HD068143、R01 AI083034、P30 AI027757 和 T32 AI007140）以及比尔和梅琳达·盖茨基金会（26469 和 41185）。
Hormonal contraceptives are used widely but their effects on HIV-1 risk are unclear. We followed 3790 heterosexual HIV-1 serodiscordant couples from seven African countries participating in two longitudinal HIV-1 incidence studies. Among hormonal contraceptive users (including injectable and oral contraceptive users) and nonusers, we compared rates of HIV-1 acquisition in women and HIV-1 transmission from women to men. Among 1314 couples in which the HIV-1 seronegative partner was female, HIV-1 acquisition rates were 6.61 and 3.78 per 100 person-years among hormonal contraceptive users and nonusers (adjusted hazard ratio [AHR]=1.98, 95% confidence interval [CI] 1.06–3.68, p=0.03). Among 2476 couples in which the HIV-1 seronegative partner was male, HIV-1 transmission rates from women to men were 2.61 and 1.51 per 100 person-years in those whose partners currently used versus did not use hormonal contraception (AHR=1.97, 95% CI 1.12–3.45, p=0.02). In subgroup analysis, injectable contraceptive users had increased risk for acquiring and transmitting HIV-1 to their partner and HIV-1 seropositive women using injectable contraception had higher genital HIV-1 RNA concentrations, suggesting a mechanism for increased transmission risk. Oral contraceptives were used too infrequently to draw definitive conclusions about HIV-1 risk. Women should be counseled about potentially increased risk of HIV-1 acquisition and transmission with hormonal contraception, particularly injectable methods, and about the importance of dual protection with condoms to decrease HIV-1 risk. Non-hormonal or lower-dose hormonal contraceptive methods should be considered for women with or at-risk for HIV-1. National Institutes of Health (R03 HD068143, R01 AI083034, P30 AI027757, and T32 AI007140) and the Bill and Melinda Gates Foundation (26469 and 41185).