Baeten Jared M, Benki Sarah, Chohan Vrasha, Lavreys Ludo, McClelland R Scott, Mandaliya Kishorchandra, Ndinya-Achola Jeckoniah O, Jaoko Walter, Overbaugh Julie
Seattle HIV Prevention Trials Unit, Department of Medicine, University of Washington, 9012 Boren Avenue, Seattle, WA 98104, USA.
AIDS. 2007 Aug 20;21(13):1771-7. doi: 10.1097/QAD.0b013e328270388a.
Studies of the effect of hormonal contraceptive use on the risk of HIV-1 acquisition have generated conflicting results. A recent study from Uganda and Zimbabwe found that women using hormonal contraception were at increased risk for HIV-1 if they were seronegative for herpes simplex virus type 2 (HSV-2), but not if they were HSV-2 seropositive.
To explore the effect of HSV-2 infection on the relationship between hormonal contraception and HIV-1 in a high-risk population. Hormonal contraception has previously been associated with increased HIV-1 risk in this population.
Data were from a prospective cohort study of 1206 HIV-1 seronegative sex workers from Mombasa, Kenya who were followed monthly. Multivariate Cox proportional hazards analyses were used to adjust for demographic and behavioral measures and incident sexually transmitted diseases.
: Two hundred and thirty-three women acquired HIV-1 (8.7/100 person-years). HSV-2 prevalence (81%) and incidence (25.4/100 person-years) were high. In multivariate analysis, including adjustment for HSV-2, HIV-1 acquisition was associated with use of oral contraceptive pills [adjusted hazard ratio (HR), 1.46; 95% confidence interval (CI), 1.00-2.13] and depot medroxyprogesterone acetate (adjusted HR, 1.73; 95% CI, 1.28-2.34). The effect of contraception on HIV-1 susceptibility did not differ significantly between HSV-2 seronegative versus seropositive women. HSV-2 infection was associated with elevated HIV-1 risk (adjusted HR, 3.58; 95% CI, 1.64-7.82).
In this group of high-risk African women, hormonal contraception and HSV-2 infection were both associated with increased risk for HIV-1 acquisition. HIV-1 risk associated with hormonal contraceptive use was not related to HSV-2 serostatus.
关于使用激素避孕对获得HIV-1风险影响的研究结果相互矛盾。乌干达和津巴布韦最近的一项研究发现，使用激素避孕的女性若2型单纯疱疹病毒（HSV-2）血清学阴性，则感染HIV-1的风险增加，而HSV-2血清学阳性的女性则不然。
探讨HSV-2感染对高危人群中激素避孕与HIV-1关系的影响。此前该人群中激素避孕与HIV-1风险增加有关。
数据来自对肯尼亚蒙巴萨1206名HIV-1血清学阴性性工作者的前瞻性队列研究，每月对她们进行随访。采用多变量Cox比例风险分析来调整人口统计学和行为指标以及新发性传播疾病。
233名女性感染了HIV-1（8.7/100人年）。HSV-2患病率（81%）和发病率（25.4/100人年）很高。在多变量分析中，包括对HSV-2进行调整后，HIV-1感染与口服避孕药的使用相关[调整后的风险比（HR）为1.46；95%置信区间（CI）为1.00 - 2.13]以及醋酸甲羟孕酮长效避孕针（调整后的HR为1.73；95%CI为1.28 - 2.34）。HSV-2血清学阴性与血清学阳性女性中，避孕对HIV-1易感性的影响无显著差异。HSV-2感染与HIV-1风险升高相关（调整后的HR为3.58；95%CI为1.64 - 7.82）。
在这组高危非洲女性中，激素避孕和HSV-2感染均与HIV-1感染风险增加有关。与激素避孕使用相关的HIV-1风险与HSV-2血清状态无关。
