Polis Chelsea B, Phillips Sharon J, Curtis Kathryn M, Westreich Daniel J, Steyn Petrus S, Raymond Elizabeth, Hannaford Philip, Turner Abigail Norris
United States Agency for International Development (USAID), Office of Population and Reproductive Health, Washington, DC, USA, 20004; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, 21205.
Department of Reproductive Health and Research, World Health Organization (WHO), Geneva, Switzerland.
Contraception. 2014 Oct;90(4):360-90. doi: 10.1016/j.contraception.2014.07.009. Epub 2014 Jul 23.
Whether use of various types of hormonal contraception (HC) affect risk of HIV acquisition is a critical question for women's health. For this systematic review, we identified 22 studies published by January 15, 2014 which met inclusion criteria; we classified thirteen studies as having severe methodological limitations, and nine studies as "informative but with important limitations". Overall, data do not support an association between use of oral contraceptives and increased risk of HIV acquisition. Uncertainty persists regarding whether an association exists between depot-medroxyprogesterone acetate (DMPA) use and risk of HIV acquisition. Most studies suggested no significantly increased HIV risk with norethisterone enanthate (NET-EN) use, but when assessed in the same study, point estimates for NET-EN tended to be larger than for DMPA, though 95% confidence intervals overlapped substantially. No data have suggested significantly increased risk of HIV acquisition with use of implants, though data were limited. No data are available on the relationship between use of contraceptive patches, rings, or hormonal intrauterine devices and risk of HIV acquisition. Women choosing progestin-only injectable contraceptives such as DMPA or NET-EN should be informed of the current uncertainty regarding whether use of these methods increases risk of HIV acquisition, and like all women at risk of HIV, should be empowered to access and use condoms and other HIV preventative measures. Programs, practitioners, and women urgently need guidance on how to maximize health with respect to avoiding both unintended pregnancy and HIV given inconclusive or limited data for certain HC methods.
使用各类激素避孕方法（HC）是否会影响感染艾滋病毒的风险，这是一个关乎女性健康的关键问题。在本次系统评价中，我们检索到截至2014年1月15日发表的22项符合纳入标准的研究；我们将其中13项研究归类为存在严重方法学局限性，9项研究归类为“有参考价值但存在重要局限性”。总体而言，数据并不支持口服避孕药的使用与感染艾滋病毒风险增加之间存在关联。醋酸甲羟孕酮长效注射剂（DMPA）的使用与感染艾滋病毒风险之间是否存在关联仍不确定。大多数研究表明，使用庚酸炔诺酮（NET-EN）不会显著增加感染艾滋病毒的风险，但在同一研究中进行评估时，NET-EN的点估计值往往大于DMPA，尽管95%置信区间有很大重叠。虽然数据有限，但尚无数据表明使用植入剂会显著增加感染艾滋病毒的风险。关于使用避孕贴片、避孕环或激素宫内节育器与感染艾滋病毒风险之间的关系，尚无可用数据。选择仅含孕激素的注射用避孕药如DMPA或NET-EN的女性，应被告知目前关于使用这些方法是否会增加感染艾滋病毒风险的不确定性，并且与所有有感染艾滋病毒风险的女性一样，应被赋予获取和使用避孕套及其他艾滋病毒预防措施的权利。鉴于某些HC方法的数据尚无定论或有限，项目、从业者和女性迫切需要有关如何在避免意外怀孕和艾滋病毒感染方面实现健康最大化的指导。
