Department of Gynecology and Obstetrics, Emory University School of Medicine.
Rwanda Zambia HIV Research Group, Department of Pathology & Laboratory Medicine, School of Medicine and Hubert Department of Global Health, Rollins School of Public Health, Emory University.
AIDS. 2018 Mar 13;32(5):595-604. doi: 10.1097/QAD.0000000000001741.
To examine bacterial vaginosis as an effect modifier for the association between hormonal contraception and incident HIV infection.
Serodiscordant couples enrolled in an open longitudinal cohort in Lusaka, Zambia from 1994 to 2012. This analysis was restricted to couples with an HIV-positive man enrolled between1994 and 2002 when a quarterly genital tract examination and HIV testing was performed.
Multivariate Cox models evaluated the association between contraceptive method and HIV-acquisition, stratified by time-varying bacterial vaginosis status.
Among 564 couples contributing 1137.2 couple-years of observation, bacterial vaginosis was detected at 15.5% of study visits. Twenty-two of 106 seroconversions occurred during intervals after bacterial vaginosis was detected [12 on no method/nonhormonal method (nonhormonal contraception), two on injectables, eight on oral contraceptive pills (OCPs)]. Unadjusted seroincidence rates per 100 couple-years for nonhormonal contraception, injectable, and OCP users, respectively, during intervals with bacterial vaginosis were 8.3, 20.8, and 31.0 and during intervals without bacterial vaginosis were 8.2, 9.7, and 12.3. In the bacterial vaginosis-positive model, there was a significant increase in incident HIV among those using injectables (adjusted hazard ratio, aHR 6.55, 95% CI 1.14-37.77) and OCPs (aHR 5.20, 95% CI 1.68-16.06) compared with nonhormonal contraception. Hormonal contraception did not increase the hazard of HIV acquisition in bacterial vaginosis-negative models. These findings persisted in sensitivity analyses whenever all covariates from the nonstratified model previously published were included, whenever other genital tract findings were excluded from the model and with the addition of condom-less sex and sperm on wet-prep.
Future research should consider a potential interaction with bacterial vaginosis whenever evaluating the impact of hormonal contraception on HIV acquisition.
研究细菌性阴道病是否为激素避孕与艾滋病毒感染之间关联的一个影响因素。
1994 年至 2012 年，在赞比亚卢萨卡，我们招募了参加一个开放的纵向队列的性伴侣，并对他们进行了研究。本分析仅限于 1994 年至 2002 年期间入组的 HIV 阳性男性伴侣，因为那时每季度进行生殖道检查和 HIV 检测。
多变量 Cox 模型评估了避孕方法与艾滋病毒感染的相关性，同时按细菌性阴道病的时间变化状态进行分层。
在 564 对提供 1137.2 对夫妻年观察的夫妇中，15.5%的研究访视时发现细菌性阴道病。在 106 例血清转换中，有 22 例发生在发现细菌性阴道病之后[12 例发生在未使用任何方法/非激素方法（非激素避孕），2 例发生在使用注射剂，8 例发生在口服避孕药（OCP）]。在细菌性阴道病阳性模型中，使用注射剂（调整后的危险比，aHR 6.55，95%CI 1.14-37.77）和 OCP（aHR 5.20，95%CI 1.68-16.06）的夫妇中，艾滋病毒感染的发生率显著增加，而非激素避孕组的发生率为 8.3、20.8 和 31.0，而无细菌性阴道病组的发生率为 8.2、9.7 和 12.3。在细菌性阴道病阳性模型中，与非激素避孕相比，使用注射剂和 OCP 会显著增加感染艾滋病毒的风险（调整后的危险比，aHR 6.55，95%CI 1.14-37.77）。在细菌性阴道病阴性模型中，激素避孕并未增加 HIV 感染的风险。在先前发表的非分层模型的所有协变量，以及从模型中排除其他生殖道发现，以及添加无保护性行为和湿片上精子的情况下，这些发现仍然存在。
在评估激素避孕对艾滋病毒感染的影响时，未来的研究应考虑细菌性阴道病的潜在相互作用。
