Richardson Barbra A, Otieno Phelgona A, Mbori-Ngacha Dorothy, Overbaugh Julie, Farquhar Carey, John-Stewart Grace C
Department of Biostatistics, University of Washington, Seattle, WA 98194-2499, USA.
AIDS. 2007 Mar 30;21(6):749-53. doi: 10.1097/QAD.0b013e328032790f.
To assess the immediate and longer-term effects of the use of hormonal contraception on the progression of HIV-1 disease in postpartum women.
A prospective cohort study.
Information on contraceptive use, breastfeeding and intercurrent illnesses was obtained from HIV-infected postpartum Kenyan women monthly in the first year postpartum and quarterly in the second year. Blood was collected for T-cell subset analyses and HIV-1-RNA levels at months 1, 3, 6, 9, 12, 18, and 24 postpartum. The immediate effect of the initiation of oral contraceptive pills (OCP) and depot medroxyprogesterone acetate (DMPA) was assessed by comparing the change in the HIV-1-RNA plasma viral load and CD4 T-cell counts among women remaining off these contraceptive methods with those initiating them. The longer-term effects of OCP and DMPA on disease progression were assessed using Loess curves and linear mixed effects models to compare changes over the first 24 months postpartum in these same disease progression markers.
There were no significant immediate or longer-term effects of the use of OCP or DMPA on HIV-1-RNA plasma viral loads and CD4 T-cell counts in this cohort of HIV-infected postpartum Kenyan women.
Comprehensive contraceptive counselling for HIV-1-infected women requires an understanding of the effects of various contraceptive methods on HIV-1 disease progression. In this study, hormonal contraception reassuringly had no immediate or longer-term effects on the rate of disease progression in chronically HIV-1-infected postpartum women. This highly effective family planning method may provide a useful and safe option for the prevention of mother-to-child transmission of HIV-1.
评估使用激素避孕法对产后女性HIV-1疾病进展的近期和长期影响。
一项前瞻性队列研究。
从肯尼亚感染HIV的产后女性那里获取避孕措施使用情况、母乳喂养情况及并发疾病信息，产后第一年每月收集一次，第二年每季度收集一次。在产后第1、3、6、9、12、18和24个月采集血液进行T细胞亚群分析及HIV-1-RNA水平检测。通过比较未采用这些避孕方法的女性与开始采用这些方法的女性之间HIV-1-RNA血浆病毒载量和CD4 T细胞计数的变化，评估口服避孕药（OCP）和醋酸甲羟孕酮长效避孕针（DMPA）开始使用的近期影响。使用局部加权回归曲线（Loess曲线）和线性混合效应模型评估OCP和DMPA对疾病进展的长期影响，以比较这些相同疾病进展标志物在产后头24个月的变化情况。
在这组肯尼亚感染HIV的产后女性中，使用OCP或DMPA对HIV-1-RNA血浆病毒载量和CD4 T细胞计数没有显著的近期或长期影响。
为感染HIV-1的女性提供全面的避孕咨询需要了解各种避孕方法对HIV-1疾病进展的影响。在本研究中，令人放心的是，激素避孕法对慢性感染HIV-1的产后女性的疾病进展速度没有近期或长期影响。这种高效的计划生育方法可能为预防HIV-1母婴传播提供一种有用且安全的选择。
