Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
Future Microbiol. 2012 Mar;7(3):315-8. doi: 10.2217/fmb.12.8.
Prior observational studies produced inconsistent findings regarding hormonal contraception (HC) and risks of HIV acquisition and transmission. Heffron et al. conducted secondary data analyses on 3790 HIV discordant couples enrolled in two studies (a randomized trial of HSV-2 suppression and a study of immune correlates of HIV-1 protection) to assess HIV-1 acquisition and transmission in relation to HC use in females. HIV incidence among female HC nonusers was 3.8/100 person years (py), compared to 6.9/100 py among injectable users (p = 0.04) and 5.9/100 py in oral contraceptive users (p = 0.33). Among men, HIV incidence was 1.5/100 py in partners of HIV-positive HC nonusers, compared to 2.6/100 py in partners of injectable users (p < 0.05) and 2.5/100 py in men whose HIV-infected partners used oral contraceptives (p = 0.31). Study strengths included frequent follow up, excellent retention, known HIV exposure and viral load in the index infected partner, genetic linkage of virus from both partners and sexual behavior information. However, confounding by factors that cannot be controlled, including misreporting of condom use, is likely, given participants' high pregnancy rates. Clinicians and clients need to balance potential HC risks with the known risks of unwanted pregnancies. Condom use remains essential for HIV prevention regardless of other contraceptive usage.
先前的观察性研究对于激素避孕（HC）与 HIV 感染和传播风险之间的关系得出了不一致的结论。Heffron 等人对两项研究（一项 HSV-2 抑制的随机试验和一项 HIV-1 保护的免疫相关性研究）中的 3790 对 HIV 不一致的夫妇进行了二次数据分析，以评估女性中与 HC 使用相关的 HIV-1 获得和传播情况。未使用 HC 的女性 HIV 感染发生率为 3.8/100 人年（py），而注射使用者为 6.9/100 py（p=0.04），口服避孕药使用者为 5.9/100 py（p=0.33）。在男性中，HIV 阳性未使用 HC 的女性伴侣的 HIV 感染发生率为 1.5/100 py，而注射使用者为 2.6/100 py（p<0.05），HIV 感染的伴侣使用口服避孕药的男性为 2.5/100 py（p=0.31）。研究的优势包括频繁的随访、良好的保留率、已知的 HIV 暴露和指数感染者的病毒载量、来自两个伴侣的病毒的遗传连锁以及性行为信息。然而，由于参与者的高怀孕率，无法控制的因素（包括避孕套使用的错误报告）可能会产生混杂。临床医生和患者需要权衡潜在的 HC 风险与意外怀孕的已知风险。无论其他避孕方法如何，避孕套的使用仍然是 HIV 预防的关键。
