Division of Reproductive Health, Centers for Disease Control and Prevention, MS K-34, 4770 Buford Highway NE, Atlanta, GA 30341, USA.
AIDS. 2009 Nov;23 Suppl 1:S55-67. doi: 10.1097/01.aids.0000363778.58203.b6.
To determine from the literature whether HIV-infected women who use hormonal or intrauterine contraception are at increased risk of HIV disease progression, other adverse health outcomes, or HIV transmission to uninfected sexual partners.
A systematic review.
We searched PubMed for articles published in peer-reviewed journals through August 2009 for evidence relevant to all hormonal and intrauterine contraceptive methods and HIV/AIDS.
Eight observational studies reported no increased risk of HIV disease progression with hormonal or intrauterine contraceptive use, whereas one randomized controlled trial found increased risks of declining CD4 cell count and death for hormonal contraceptive users compared with intrauterine device users. Women with HIV who used hormonal contraception had increased risks of acquiring sexually transmitted infections compared with women not using hormonal contraception, similar to the risks reported among uninfected women. One study found no association between hormonal or intrauterine contraceptive use and increased risk of HIV transmission to uninfected partners, whereas findings from nine studies examining contraceptive use and viral shedding from the genital tract were inconsistent.
Evidence regarding the safety of hormonal and intrauterine contraceptive use among women with HIV remains limited, but generally reassuring regarding adverse health effects, disease transmission to uninfected partners, and disease progression; however, one randomized trial raised concerns about enhanced disease progression among women using hormonal contraception. Preventing unintended pregnancy among women with HIV remains a high priority in public health, both for the health of the woman as well as for the prevention of mother-to-child transmission of HIV.
从文献中确定感染 HIV 的女性使用激素或宫内节育器是否会增加 HIV 疾病进展、其他不良健康结局或 HIV 传播给未感染的性伴侣的风险。
系统评价。
我们在 PubMed 中搜索了截至 2009 年 8 月发表在同行评议期刊上的与所有激素和宫内节育器方法以及 HIV/AIDS 相关的证据。
八项观察性研究报告称，使用激素或宫内节育器不会增加 HIV 疾病进展的风险，而一项随机对照试验发现，与宫内节育器使用者相比，激素避孕药使用者的 CD4 细胞计数下降和死亡风险增加。与未使用激素避孕药的女性相比，使用激素避孕药的 HIV 女性感染性传播感染的风险增加，与未感染女性报告的风险相似。一项研究发现，激素或宫内节育器的使用与增加感染未感染伴侣的 HIV 风险之间没有关联，而九项研究检查了避孕措施和生殖道病毒脱落，结果不一致。
关于 HIV 女性使用激素和宫内节育器的安全性的证据仍然有限，但总体上对不良健康影响、未感染伴侣的疾病传播和疾病进展是令人放心的；然而，一项随机试验对使用激素避孕药的女性疾病进展增强提出了担忧。预防 HIV 女性的意外怀孕仍然是公共卫生的一个高度优先事项，这对女性的健康以及预防母婴传播 HIV 都很重要。
