Effects of continued Progestin-based contraceptive usage in the adolescent genital tract: implications for HIV acquisition

孕激素为基础的避孕药在女性生殖道的持续使用：影响 艾滋病病毒的感染。 全球青春期少女的艾滋病毒负担很大，占所有新感染病例的22%。这 人口也受到经常意外怀孕的严重影响，约占所有人口的11%。 全球出生。因此，不增加感染艾滋病毒风险的安全有效避孕药具 在这一人群中的传播情况需要紧急评估。 已发现基于孕激素的避孕药DMPA与增强的HIV相关 在成年女性中获得/传播。然而，尚未评估对青少年的影响。现有数据 表明青少年生殖器免疫微环境是独特的，其特征是高基线 炎症和宫颈异位的存在可能有助于增强HIV易感性。是 目前尚不清楚继续使用孕激素避孕药是否会进一步增加艾滋病毒感染率 这个人群的敏感性。 本提案的总体目标是评估继续使用三种类型的 孕激素避孕药，左炔诺孕酮宫内节育器（LNG-IUD），皮下依托孕烯（ETNG）， 和醋酸甲羟孕酮（DMPA），对炎症和微生物环境的影响， 青春期少女的生殖道。 我们提出了一项纵向研究，以评估50名性活跃， 15-19岁HIV阴性少女使用孕激素避孕药前后的比较 女孩使用复方口服避孕药（雌激素和黄体酮）或仅使用避孕套。我们的中央 一种假设是，继续使用孕激素避孕药会损害免疫保护， 青春期生殖道 该提案的重点是青春期女孩的艾滋病毒风险，这是NIH的优先人群。对拟议数据的评估 在这项研究中，将提醒医学界迄今尚未探索的风险和比较孕激素为基础的 使用避孕药具。这将刺激进一步的研究，并导致充分知情的避孕建议 这些选择可能会改善少女的整体生殖健康。

EffectsofcontinuedProgestin-basedcontraceptiveusageintheadolescentgenitaltract:implications for HIV acquisition. The global burden of HIV in adolescent girls is significant, accounting for 22% of all new infections. This population is also heavily impacted by often-unintended pregnancies accounting for approximately 11% of all births worldwide. Therefore, safe and effective contraceptives which does not increase risks of HIV acquisition and transmission needs to be urgently evaluated in this population. Progestin based contraceptive DMPA have been found to be associated with enhanced HIV acquisition/transmission in adult women. However, effects in adolescents have not been evaluated. Existing data indicates adolescent genital immune microenvironment to be distinct and characterized by high baseline inflammation and presence of cervical ectopy which might be conducive to enhanced HIV susceptibility. It is currently unknown whether continued usage of progestin-based contraceptives can further enhance HIV susceptibility in this population. The overall objective of this proposal is to evaluate the biological impact of continued use of three types of progestin-based contraceptives, levonorgestrel intrauterine device (LNG-IUD), subdermal etonogestrel (ETNG), and Depot medroxyprogesterone acetate (DMPA), on the inflammatory and microbiologic environment in the genital tract of adolescent girls. We propose a longitudinal study to evaluate immune microenvironment in the genital tract in fifty sexually active, HIV negative adolescent girls aged 15-19 before and after using progestin-based contraceptives and compare with girls using combined oral contraceptives (estrogen and progesterone) or condoms-only. Our central hypothesis is that continued usage of progestin-based contraceptives will compromise immune protection in adolescent genital tract. This proposal focuses on HIV risks in adolescent girls, a priority population for NIH. Assessment of data proposed in this study will alert the medical community of to date unexplored risks and a comparison of progestin-based contraceptive use. This will spur further research and lead to well-informed recommendations for contraceptive choices that may improve overall reproductive health in adolescent girls.