Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa.
Trop Med Int Health. 2020 Jul;25(7):790-802. doi: 10.1111/tmi.13401. Epub 2020 May 13.
To evaluate the evidence on the effectiveness of vaginal microbicides in preventing HIV transmission in women.
Systematic review through a comprehensive search of relevant electronic databases for eligible randomised controlled trials (RCTs) published through June 2019. Two authors independently screened titles and abstracts according to eligibility criteria, then extracted data and assessed risk of bias of included studies. We conducted a random-effects meta-analysis of risk ratios (RR) of HIV infection and assessed heterogeneity using chi-squared and I tests. Sources of heterogeneity were investigated through subgroup analysis, publication bias was assessed using funnel plots, and certainty of evidence was graded using GRADEPro software.
We included 18 RCTs which enrolled 40,048 sexually active, HIV-negative, non-pregnant women, aged 16 years and older, mainly from sub-Saharan Africa. The intravaginal ring containing dapivirine significantly reduced HIV risk by 29% (RR 0.71, 95% CI: 0.57-0.89; 2 RCTs, 4,564 women, moderate certainty of evidence). Estimates of effect of tenofovir 1% (RR 0.83, 95% CI: 0.65-1.06), nonoxynol-9 (RR 1.15, 95% CI: 0.93-1.42), cellulose sulphate (RR 1.16, 95% CI: 0.61-2.21), SAVVY (RR 1.34, 95% CI: 0.69-2.59), Carraguard (RR 0.89, 95% CI: 0.71-1.10), BufferGel (RR 1.02, 95% CI: 0.71-1.46), 0.5% PRO2000 (RR 0.88, 95% CI: 0.60-1.28) and 2% PRO2000 (RR 0.81, 95% CI: 0.58-1.12) failed to reach statistical significance; each had low certainty of evidence.
The long-acting intravaginal ring containing dapivirine significantly reduced risk of HIV transmission in women by 29%. The remaining microbicides had no evident effect.
评估阴道杀微生物剂预防女性 HIV 传播的有效性证据。
通过全面检索相关电子数据库，对截至 2019 年 6 月发表的合格随机对照试验（RCT）进行系统评价。两位作者根据纳入标准独立筛选标题和摘要，然后提取数据并评估纳入研究的偏倚风险。我们对 HIV 感染的风险比（RR）进行了随机效应荟萃分析，并使用卡方和 I 检验评估异质性。通过亚组分析调查异质性的来源，使用漏斗图评估发表偏倚，并使用 GRADEPro 软件评估证据确定性。
我们纳入了 18 项 RCT，共纳入了 40048 名性活跃、HIV 阴性、非妊娠、年龄在 16 岁及以上的女性，主要来自撒哈拉以南非洲。含有 dapivirine 的阴道环显著降低了 29%的 HIV 风险（RR 0.71，95%CI：0.57-0.89；2 项 RCT，4564 名女性，中等确定性证据）。替诺福韦 1%（RR 0.83，95%CI：0.65-1.06）、壬苯醇醚-9（RR 1.15，95%CI：0.93-1.42）、纤维素硫酸酯（RR 1.16，95%CI：0.61-2.21）、SAVVY（RR 1.34，95%CI：0.69-2.59）、Carraguard（RR 0.89，95%CI：0.71-1.10）、BufferGel（RR 1.02，95%CI：0.71-1.46）、0.5% PRO2000（RR 0.88，95%CI：0.60-1.28）和 2% PRO2000（RR 0.81，95%CI：0.58-1.12）未能达到统计学意义；每个都有低确定性证据。
含有 dapivirine 的长效阴道环可显著降低女性 HIV 传播风险 29%。其余杀微生物剂没有明显效果。
