Heffron Renee, Mugo Nelly, Were Edwin, Kiarie James, Bukusi Elizabeth A, Mujugira Andrew, Frenkel Lisa M, Donnell Deborah, Ronald Allan, Celum Connie, Baeten Jared M
aDepartment of Global Health bDepartment of Medicine cDepartment of Epidemiology dPediatrics & Laboratory Medicine eDepartment of Obstetrics and Gynecology, University of Washington, Seattle, Washington, USA fCenter for Clinical Research, Kenya Medical Research Institute, Nairobi gDepartment of Reproductive Health, Moi University, Eldoret hDepartment of Obstetrics & Gynecology, University of Nairobi and Kenyatta National Hospital iCenter for Microbiology, Kenya Medical Research Institute, Nairobi, Kenya jVaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA kDepartments of Medicine and Medical Microbiology, University of Manitoba, Winnipeg, Canada. *The Partners PrEP Study Team is listed in the Acknowledgements.
AIDS. 2014 Nov 28;28(18):2771-6. doi: 10.1097/QAD.0000000000000493.
To evaluate preexposure prophylaxis (PrEP) efficacy for HIV-1 prevention among women using depot medroxyprogesterone acetate (DMPA) for contraception and men whose HIV-1-infected partners use DMPA.
Secondary analysis of data from a randomized placebo-controlled trial of daily oral tenofovir and emtricitabine/tenofovir PrEP among heterosexual Kenyan and Ugandan HIV-1 serodiscordant couples.
PrEP efficacy for HIV-1 prevention was compared among HIV-1-uninfected women using DMPA versus no hormonal contraception and among HIV-1 uninfected men whose HIV-1-infected female partners used DMPA versus no hormonal contraception.
Of 4747 HIV-1 serodiscordant couples, 901 HIV-1-uninfected women used DMPA at some point during follow-up, 1422 HIV-1-uninfected women used no hormonal contraception, 1568 HIV-1-uninfected men had female partners who used DMPA, and 2626 men had female partners who used no hormonal contraception. PrEP efficacy estimates for HIV-1 prevention, compared with placebo, were similar among women using DMPA and those using no hormonal contraception (64.7 and 75.5%, adjusted interaction P = 0.65). Similarly, for men whose female partners used DMPA, PrEP efficacy did not differ from men whose partners used no hormonal contraception (90.0 versus 81.7%, adjusted interaction P = 0.52).
PrEP is efficacious for HIV-1 prevention among women using DMPA and men whose partners use DMPA, suggesting PrEP could mitigate the potential increased HIV-1 acquisition and transmission risks that have been associated with DMPA use. Women at risk for HIV-1 choosing DMPA could maintain this contraceptive method and add PrEP to achieve prevention of unintended pregnancy and HIV-1.
评估在使用醋酸甲羟孕酮长效避孕针（DMPA）避孕的女性以及其感染HIV-1的伴侣使用DMPA的男性中，暴露前预防（PrEP）对预防HIV-1的效果。
对肯尼亚和乌干达异性恋HIV-1血清学不一致夫妇中每日口服替诺福韦以及恩曲他滨/替诺福韦PrEP的随机安慰剂对照试验数据进行二次分析。
比较使用DMPA的未感染HIV-1的女性与未使用激素避孕的女性之间以及其感染HIV-1的女性伴侣使用DMPA的未感染HIV-1的男性与未使用激素避孕的男性之间预防HIV-1的PrEP效果。
在4747对HIV-1血清学不一致的夫妇中，901名未感染HIV-1的女性在随访期间的某个时间点使用了DMPA，1422名未感染HIV-1的女性未使用激素避孕，1568名未感染HIV-1的男性其女性伴侣使用了DMPA，2626名男性其女性伴侣未使用激素避孕。与安慰剂相比，使用DMPA的女性和未使用激素避孕的女性中预防HIV-1的PrEP效果估计相似（分别为64.7%和75.5%，校正交互作用P = 0.65）。同样，对于其女性伴侣使用DMPA的男性，PrEP效果与伴侣未使用激素避孕的男性没有差异（分别为90.0%和81.7%，校正交互作用P = 0.52）。
PrEP对使用DMPA的女性以及其伴侣使用DMPA的男性预防HIV-1有效，这表明PrEP可以减轻与使用DMPA相关的潜在增加的HIV-1感染和传播风险。有HIV-1感染风险且选择DMPA的女性可以维持这种避孕方法并加用PrEP以实现预防意外怀孕和HIV-1感染。
