避孕套与壬苯醇醚-9对HIV感染的防护作用。
The protective effect of condoms and nonoxynol-9 against HIV infection.
作者信息
Wittkowski K M, Susser E, Dietz K
机构信息
HIV Center, New York Psychiatric Institute, New York City, USA.
出版信息
Am J Public Health. 1998 Apr;88(4):590-6. doi: 10.2105/ajph.88.4.590.
OBJECTIVES
Whether or not spermicides can reduce the risk of human immunodeficiency virus (HIV) transmission remains an important question for the control of heterosexual HIV transmission. The authors provide estimates from a reanalysis of one of the few observational studies on the efficacy of condoms and spermicides, used separately and together, per vaginal contact.
METHODS
In this reanalysis, three different models were used to assess the efficacy of spermicides and condoms: linear (Pearl index), exponential (maximum likelihood), and monotonic (marginal likelihood).
RESULTS
Reported use of barrier methods among 27,432 contacts was as follows: condoms plus nonoxynol-9, 39%; condoms alone, 25%; nonoxynol-9 alone, 24%; and unprotected, 11%. Under all three models, the results indicate a strong protective effect for spermicidal suppositories. The Pearl index indicated that spermicide alone is apparently efficacious, but the efficacy per contact cannot be quantified with this approach. Maximum likelihood estimates for the efficacy of nonoxynol-9 alone and condoms (with or without nonoxynol-9) were 100% (95% confidence interval [CI95] = 43%, 100%) and 92% (95% CI95 = 79%, 100%), respectively.
CONCLUSIONS
The data from this observational study suggest that spermicides may be efficacious in reducing the risk of HIV transmission.
目的
杀精剂能否降低人类免疫缺陷病毒（HIV）传播风险，对于控制异性间HIV传播而言仍是一个重要问题。作者通过重新分析为数不多的关于单独及联合使用避孕套和杀精剂对每次阴道接触的有效性的观察性研究之一，给出了相关估计。
方法
在此次重新分析中，使用了三种不同模型来评估杀精剂和避孕套的有效性：线性模型（珀尔指数）、指数模型（最大似然法）和单调模型（边际似然法）。
结果
在27432次接触中，屏障方法的使用情况如下：避孕套加壬苯醇醚-9，39%；仅使用避孕套，25%；仅使用壬苯醇醚-9，24%；无保护措施，11%。在所有三种模型下，结果均表明杀精栓剂具有很强的保护作用。珀尔指数表明单独使用杀精剂显然有效，但用这种方法无法量化每次接触的有效性。单独使用壬苯醇醚-9和避孕套（含或不含壬苯醇醚-9）的最大似然估计有效性分别为100%（95%置信区间[CI95]=43%，100%）和92%（95%CI95=79%，100%）。
结论
这项观察性研究的数据表明，杀精剂可能在降低HIV传播风险方面有效。
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