aOffice of Population and Reproductive Health, United States Agency for International Development (USAID), Washington, DC bDepartment of Epidemiology, University of North Carolina, Chapel Hill cDepartment of Obstetrics & Gynecology and Global Health Institute, Duke University, Durham, North Carolina dVaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center eDepartment of Global Health, University of Washington, Seattle, Washington, USA. *Chelsea B. Polis, Daniel Westreich, Jennifer E. Balkus and Renee Heffron contributed equally to the writing of the article.
AIDS. 2013 Oct;27 Suppl 1(0 1):S35-43. doi: 10.1097/QAD.0000000000000036.
Determining whether hormonal contraception, particularly the injectable contraceptive depot-medroxyprogesterone acetate (DMPA), increases a woman's risk of HIV acquisition is a priority question for public health. However, assessing the relationship between various hormonal contraceptive methods and HIV acquisition with observational data involves substantial analytic design issues and challenges. Studies to date have used inconsistent approaches and generated a body of evidence that is complex and challenging to interpret.
In January 2013, the United States Agency for International Development and FHI 360 supported a meeting of epidemiologists, statisticians, and content experts to develop recommendations for future observational analyses of hormonal contraception and HIV acquisition.
Meeting participants generated recommendations regarding careful definition of exposure groups; handling potential confounders, mediators, and effect modifiers; estimating and addressing the magnitude of measurement error; using multiple methods to account for pregnancy; and exploring the potential for differential exposure to HIV-infected partners. Advantages and disadvantages of various statistical approaches to account for time-varying confounding and estimating total and direct effects were also discussed.
Implementing these recommendations in future observational hormonal contraception-HIV acquisition analyses will enhance interpretation of existing studies and strengthen the overall evidence base for this complex and important area.
确定激素避孕方法，特别是注射用醋酸甲羟孕酮（DMPA）是否会增加女性感染艾滋病毒的风险，这是公共卫生的一个优先问题。然而，使用观察性数据评估各种激素避孕方法与艾滋病毒感染之间的关系涉及到大量分析设计问题和挑战。迄今为止的研究采用了不一致的方法，并产生了一系列复杂且难以解释的证据。
2013 年 1 月，美国国际开发署和 FHI 360 支持召开了一次流行病学家、统计学家和内容专家会议，为今后关于激素避孕和艾滋病毒感染的观察性分析制定建议。
与会者就以下方面提出了建议：仔细定义暴露组；处理潜在的混杂因素、中介因素和效应修饰因素；估计和解决测量误差的大小；使用多种方法来处理妊娠问题；以及探索对感染艾滋病毒的伴侣的潜在不同暴露情况。还讨论了各种统计方法在处理时变混杂因素和估计总效应和直接效应方面的优缺点。
在今后关于激素避孕与艾滋病毒感染的观察性分析中实施这些建议，将有助于解释现有研究，并为这一复杂而重要领域的整体证据基础提供支持。
