ECHO: context and limitations.
ECHO: context and limitations.
复制标题
ECHO：背景和限制。
DOI：
10.1016/s0140-6736(19)33107-1
复制
发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Cherpes,ThomasL
中科院分区：
文献类型：
--
作者：
Miguel,RodolfoDVicetti;Calla,NirkEQuispe;Aceves,KristenM;Lopez,FiorelaCDueñas;Cherpes,ThomasL
我们饶有兴趣地阅读了ECHO试验的第一份公开报告，1该报告显示，肌肉注射长效醋酸甲羟孕酮（DMPA）、左炔诺孕酮（LNG）植入物或铜宫内节育器（IUD）避孕的妇女的HIV风险无显著差异。这份报告可能会深刻影响那些年轻女性感染艾滋病毒的比例过高的国家的公共卫生和计划生育政策，我们认为，对研究结果和结论发表评论是适当的，因为这些结果似乎产生了更多的问题而不是答案。一个意想不到的和未充分解决的结果是，随机分配到DMPA和长效可逆避孕（LARC）的妇女的性行为不同。虽然研究参与者在登记时有类似的行为，但在随访期间的性行为自我报告中发现了更多的多个性伴侣和新的性伴侣，以及随机分配到LNG植入物和铜IUD组的女性的无保护性行为（所有p< 0. 001）。尽管作者的结论是，在开始使用LARC的妇女中，高危活动的高度显著增加并没有混淆数据解释，但这种自发性的变化似乎值得评论。同样值得注意的是，超过10%的入选妇女的血清MPA浓度表明在过去3个月内使用DMPA。ECHO试验将近期使用DMPA列为排除标准，但这些妇女的数据是否被删失尚不清楚。潜在的最大影响是，在ECHO研究中无法将妇女随机分配到无避孕组，这使得风险因素识别依赖于不同的结果。研究设计的这一要求是相关的，因为LNG植入物和铜IUD对HIV传播的影响基本上是未知的，
We read with interest the first public report from the ECHO trial, 1 which showed no significant differences in HIV risk in women using intramuscular injection of depot medroxyprogesterone acetate (DMPA), levonorgestrel (LNG) implant, or copper intrauterine device (IUD) for contraception. This report might profoundly affect public health and family planning policies in countries where disproportionate numbers of young women live with HIV, and we feel that it is appropriate to comment on study results and conclusions that seem to generate more questions than answers.One unexpected and inadequately addressed result is the dissimilar sexual behaviour in women randomly assigned to DMPA versus long-acting reversible contraception (LARC). Although study participants had similar behaviour at enrolment, self-report of sexual behaviour during follow-up identified more multiple and new sexual partners, and unprotected sex in women randomly assigned to the LNG implant and copper IUD groups (all p< 0∙ 001). Despite the authors conclusion that the highly significant increase in high-risk activity in women beginning LARC use did not confound data interpretation, this behavourial change seems worth commenting on. Also worth addressing is the observation that more than 10% of women enrolled had serum MPA concentrations indicating DMPA use in the previous 3 months. Recent DMPA use was listed as an exclusion criterium in the ECHO trial, but whether data from these women were censored is unclear. Of potential greatest impact, the inability to randomly assign women to a no contraceptive group in the ECHO study made risk factor identification dependent on a differential outcome. This requirement of study design is relevant because effects of LNG implant and copper IUD on HIV transmission are essentially unknown,