Tepper Naomi K, Krashin Jamie W, Curtis Kathryn M, Cox Shanna, Whiteman Maura K
Div of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.
MMWR Morb Mortal Wkly Rep. 2017 Sep 22;66(37):990-994. doi: 10.15585/mmwr.mm6637a6.
CDC's U.S. Medical Eligibility Criteria for Contraceptive Use (U.S. MEC) (first published in 2010 and updated in 2016) provides evidence-based guidance for the safe use of contraceptive methods among U.S. women with certain characteristics or medical conditions (1), and is adapted from global guidance from the World Health Organization (WHO) and kept up to date based on continual review of published literature (2).* CDC recently evaluated the evidence and the updated WHO guidance on the risk for human immunodeficiency virus (HIV) acquisition among women using hormonal contraception. After careful review, CDC adopted the updated WHO guidance for inclusion in the U.S. MEC guidance; this guidance states that the advantages of progestin-only injectable contraceptive use (including depot medroxyprogesterone acetate [DMPA]) by women at high risk for HIV infection outweigh the theoretical or proven risks (U.S. MEC category 2). The guidance also includes an accompanying updated clarification, which states that "there continues to be evidence of a possible increased risk of acquiring HIV among progestin-only injectable users. Uncertainty exists about whether this is due to methodological issues with the evidence or a real biological effect. In many settings, unintended pregnancies and/or pregnancy-related morbidity and mortality are common, and progestin-only injectables are among the few types of methods widely available. Women should not be denied the use of progestin-only injectables because of concerns about the possible increased risk. Women considering progestin-only injectables should be advised about these concerns, about the uncertainty over whether there is a causal relationship, and about how to minimize their risk of acquiring HIV." Recommendations for other hormonal contraceptive methods (including combined hormonal methods, implants, and progestin-only pills) remain the same; there is no restriction for their use among women at high risk for HIV infection (U.S. MEC category 1).
美国疾病控制与预防中心（CDC）的《美国避孕方法医学适用标准》（U.S. MEC）（于2010年首次发布，并于2016年更新）为具有某些特征或患有某些疾病的美国女性安全使用避孕方法提供了循证指南（1），该指南改编自世界卫生组织（WHO）的全球指南，并根据对已发表文献的持续审查进行更新（2）。*CDC最近评估了关于使用激素避孕的女性感染人类免疫缺陷病毒（HIV）风险的证据以及WHO的更新指南。经过仔细审查，CDC采用了更新后的WHO指南并纳入U.S. MEC指南；该指南指出，HIV感染高危女性使用仅含孕激素的注射用避孕药（包括醋酸甲羟孕酮长效注射剂[DMPA]）的益处超过了理论上或已证实的风险（U.S. MEC 2级）。该指南还包括一份随附的更新说明，其中指出“仍有证据表明仅含孕激素注射剂使用者感染HIV的风险可能增加。对于这是由于证据的方法学问题还是真正的生物学效应，尚存在不确定性。在许多情况下，意外怀孕和/或与怀孕相关的发病率和死亡率很常见，而仅含孕激素的注射剂是少数广泛可用的避孕方法之一。不应因担心可能增加的风险而拒绝女性使用仅含孕激素的注射剂。应向考虑使用仅含孕激素注射剂的女性告知这些担忧、关于是否存在因果关系的不确定性以及如何将感染HIV的风险降至最低。”对于其他激素避孕方法（包括复方激素方法、植入剂和仅含孕激素的口服避孕药）的建议保持不变；在HIV感染高危女性中使用这些方法没有限制（U.S. MEC 1级）。
