Kapiga S H, Lyamuya E F, Lwihula G K, Hunter D J
Department of Epidemiology and Biostatistics, Muhimbili University College of Health Sciences, Dar es Salaam, Tanzania.
AIDS. 1998 Jan 1;12(1):75-84. doi: 10.1097/00002030-199801000-00009.
To determine the risk factors for HIV seroconversion and assess the association between contraceptive use and HIV infection among women attending three large family planning clinics in Dar es Salaam, Tanzania.
Prospective cohort study.
Between 1992 and 1995, 2471 HIV-negative women were followed prospectively. Information about sociodemographic characteristics, sexual behavior, contraceptive use and other risk factors was collected at recruitment and updated at follow-up visits. At the end of the study, specimens were collected for HIV testing and laboratory diagnosis of sexually transmitted diseases.
The overall HIV incidence was 3.4 per 100 person-years [95% confidence interval (Cl), 2.6-4.1]. The risk of HIV seroconversion decreased with increasing age (P=0.04, test for trend). Women reporting three or more sex partners during the follow-up period had the highest risk of HIV [age-adjusted relative risk (RR), 4.89; 95% Cl, 2.61-9.17]. Having an uncircumcised husband was associated with a significantly increased risk of HIV (age-adjusted RR, 3.60; 95% Cl, 1.12-11.59). The risk of HIV was also significantly increased among women with gonorrhoea (age-adjusted RR, 3.51; 95% Cl, 1.60-7.71) and candidiasis at baseline (age-adjusted RR, 1.98; 95% Cl, 1.17-3.33) and among women reporting alcohol consumption during the follow-up period. After controlling for other risk factors, the risk of HIV infection amongst users of oral contraceptive, intrauterine device and injectable contraceptive was not significantly increased. Similarly, there was no significant trend associated with increasing duration of use of any of these contraceptive methods.
These findings confirm that a large number of new HIV infections continue to occur in this population. Reassuringly, no significant association was observed between HIV and use of specific contraceptive methods. Interventions to reduce further spread of HIV are still urgently needed.
确定坦桑尼亚达累斯萨拉姆市三家大型计划生育诊所就诊女性中HIV血清转化的危险因素，并评估避孕措施的使用与HIV感染之间的关联。
前瞻性队列研究。
1992年至1995年期间，对2471名HIV阴性女性进行前瞻性随访。在招募时收集有关社会人口学特征、性行为、避孕措施使用及其他危险因素的信息，并在随访时更新。研究结束时，采集标本进行HIV检测和性传播疾病的实验室诊断。
HIV总体发病率为每100人年3.4例[95%置信区间（Cl），2.6 - 4.1]。HIV血清转化风险随年龄增长而降低（P = 0.04，趋势检验）。在随访期间报告有三个或更多性伴侣的女性感染HIV的风险最高[年龄调整相对风险（RR），4.89；95% Cl，2.61 - 9.17]。丈夫未行包皮环切术与HIV感染风险显著增加相关（年龄调整RR，3.60；95% Cl，1.12 - 11.59）。基线时有淋病（年龄调整RR，3.51；95% Cl，1.60 - 7.71）和念珠菌病（年龄调整RR，1.98；95% Cl，1.17 - 3.33）的女性以及在随访期间报告饮酒的女性感染HIV的风险也显著增加。在控制其他危险因素后，口服避孕药、宫内节育器和注射用避孕药使用者中HIV感染风险未显著增加。同样，使用这些避孕方法中任何一种的时间延长均未发现显著趋势。
这些发现证实该人群中仍有大量新的HIV感染发生。令人欣慰的是，未观察到HIV与特定避孕方法的使用之间存在显著关联。仍迫切需要采取干预措施以减少HIV的进一步传播。
