Heikinheimo Oskari, Lähteenmäki Pekka
Department of Obstetrics and Gynaecology, University of Helsinki, Finland.
Hum Reprod Update. 2009 Mar-Apr;15(2):165-76. doi: 10.1093/humupd/dmn049. Epub 2008 Nov 1.
More than 15 million women, many of reproductive age, were infected with human immunodeficiency virus (HIV) at the end of 2007. As the HIV epidemic evolves, heterosexual intercourse is increasingly risky: the risk of infection in exposed young women is 4- to 7-fold higher than in young men and nearly half a million newborns annually have HIV. This review aims to show the effect of contraceptive choices on risk of HIV and on the course of disease in women with HIV.
Relevant citations were selected by agreement between the authors after a search of MEDLINE using the terms HIV/AIDS and contraception.
Risk of transmission of HIV varies from 1 in 200 to 1 in 10 000 coital incidents, depending in part on the integrity of the vaginal epithelium. Consistent use of male condoms has been proven to reduce horizontal transmission of HIV by 80% among HIV-serodiscordant couples. Hormonal contraception may increase the risk of HIV acquisition in high-risk women such as commercial sex workers, but not in women at low risk of HIV. While hormonal contraception did not affect progression of disease in two cohort studies involving 370 women, in a randomized trial among women not receiving antiretroviral medication, clinical disease accelerated in the oral contraception group (13.2/100 woman-years) compared with the copper intrauterine devices group (8.6/100 woman-years; hazard ratio, 1.5; 95% confidence interval, 1.04-2.1). Hormonal contraception does not interfere with antiviral drug effectiveness.
All the available reversible contraceptive methods can generally be used by women at risk of HIV infection and by HIV-infected women. Further studies are needed to investigate the safety and efficiency of hormonal contraception in women living with HIV/AIDS.
2007年底，超过1500万妇女感染了人类免疫缺陷病毒（HIV），其中许多处于育龄期。随着HIV疫情的发展，异性性行为的风险越来越高：暴露于HIV的年轻女性感染风险比年轻男性高4至7倍，每年有近50万新生儿感染HIV。本综述旨在展示避孕选择对HIV感染风险以及HIV感染女性疾病进程的影响。
作者们通过使用“HIV/艾滋病”和“避孕”等术语检索MEDLINE后达成共识，选择了相关文献。
HIV传播风险在每200至10000次性交事件中为1例，部分取决于阴道上皮的完整性。已证实坚持使用男用避孕套可使HIV血清学不一致的夫妇间HIV水平传播降低80%。激素避孕可能会增加高危女性（如商业性工作者）感染HIV的风险，但不会增加低HIV感染风险女性的感染风险。虽然在两项涉及370名女性患者的队列研究中，激素避孕并未影响疾病进展，但在一项针对未接受抗逆转录病毒药物治疗的女性的随机试验中，口服避孕药组（每100女性年13.2例）的临床疾病进展速度比铜宫内节育器组（每100女性年8.6例；风险比，1.5；95%置信区间，1.04 - 2.1）更快。激素避孕不干扰抗病毒药物的疗效。
所有现有的可逆避孕方法一般都可供有HIV感染风险的女性和HIV感染女性使用。需要进一步研究来调查激素避孕在感染HIV/艾滋病女性中的安全性和有效性。
