在乌干达和津巴布韦，激素避孕方法的使用与艾滋病毒疾病的进展。
Hormonal contraceptive use and HIV disease progression among women in Uganda and Zimbabwe.
机构信息
Department of Clinical Sciences, Family Health International, Research Triangle Park, NC, USA.
出版信息
J Acquir Immune Defic Syndr. 2011 Jun 1;57(2):157-64. doi: 10.1097/QAI.0b013e318214ba4a.
BACKGROUND
HIV-infected women need highly effective contraception to reduce unintended pregnancies and mother-to-child HIV transmission. Previous studies report conflicting results regarding the effect of hormonal contraception on HIV disease progression.
METHODS
HIV-infected women in Uganda and Zimbabwe were recruited immediately after seroconversion; CD4 testing and clinical examinations were conducted quarterly. The study end point was time to AIDS (two successive CD4 200 cells/mm or less or World Health Organization advanced Stage 3 or Stage 4 disease). We used marginal structural Cox survival models to estimate the effect of cumulative exposure to depot-medroxyprogesterone acetate and oral contraceptives on time to AIDS.
RESULTS
Three hundred three HIV-infected women contributed 1408 person-years. One hundred eleven women (37%) developed AIDS. Cumulative probability of AIDS was 50% at 7 years and did not vary by country. AIDS incidence was 6.6, 9.3, and 8.8 per 100 person-years for depot-medroxyprogesterone acetate, oral contraceptive, and nonhormonal users. Neither depot-medroxyprogesterone acetate (adjusted hazard ratio, 0.90; 95% confidence interval, 0.76-1.08) nor oral contraceptives ( adjusted hazard ratio, 1.07; 95% confidence interval, 0.89-1.29) were associated with HIV disease progression. Alternative exposure definitions of hormonal contraception use during the year before AIDS or at the time of HIV infection produced similar results. Sexually transmitted infection symptoms were associated with faster progression, whereas young age at HIV infection (18-24 years) was associated with slower progression. Adding baseline CD4 level and set point viral load to models did not change the hormonal contraception results, but Subtype D infection became associated with disease progression.
CONCLUSION
Hormonal contraceptive use was not associated with more rapid HIV disease progression, but older age, sexually transmitted infection symptoms, and Subtype D infection were.
背景
感染 HIV 的女性需要高效的避孕方法来减少意外怀孕和母婴 HIV 传播。之前的研究报告称荷尔蒙避孕对 HIV 疾病进展的影响结果相互矛盾。
方法
乌干达和津巴布韦的 HIV 感染女性在血清转换后立即入组；每季度进行 CD4 检测和临床检查。研究终点为艾滋病时间（连续两次 CD4 细胞数 200 个/立方毫米或更低，或世界卫生组织晚期 3 或 4 期疾病）。我们使用边缘结构 Cox 生存模型来估计累积使用 depot-medroxyprogesterone acetate 和口服避孕药对艾滋病时间的影响。
结果
303 名 HIV 感染女性贡献了 1408 人年。111 名女性（37%）发展为艾滋病。7 年内艾滋病累积发生率为 50%，且不受国家影响。depot-medroxyprogesterone acetate、口服避孕药和非荷尔蒙使用者的艾滋病发病率分别为 6.6、9.3 和 8.8/100 人年。depot-medroxyprogesterone acetate（调整后的危险比，0.90；95%置信区间，0.76-1.08）和口服避孕药（调整后的危险比，1.07；95%置信区间，0.89-1.29）均与 HIV 疾病进展无关。在艾滋病前一年或感染 HIV 时使用荷尔蒙避孕的替代暴露定义也产生了类似的结果。性传播感染症状与进展较快有关，而 HIV 感染时年龄较小（18-24 岁）与进展较慢有关。在模型中加入基线 CD4 水平和设定点病毒载量并没有改变荷尔蒙避孕的结果，但 D 型感染与疾病进展有关。
结论
荷尔蒙避孕的使用与 HIV 疾病进展的速度没有关联，但年龄较大、性传播感染症状和 D 型感染与疾病进展有关。
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