HSV状态对高风险妇女的口服避孕药使用和HIV感染无关


  August 2, 2007 (西雅图) — 一篇新的研究发现,单纯疱疹病毒第二型(Herpes simplex virus 2,HSV-2)血清阴性或血清阳姓妇女之间,荷尔蒙类避孕药使用在HIV血清转换期(seroconversion)风险的效果没有显著不同。研究结果来自1206位女性非洲性工作者的前溯世代研究,这些人在开始时是HIV-1血清阴性,研究结果发表于国际性病研究学会第17届会议,根据研究的主要作者,华盛顿大学感染症专家Jared Baeten医师表示,不论是用口服避孕药(OCs) 或者长效黄体素如depot medroxyprogesterone acetate (DMPA),增加了HIV-1血清转换风险,HSV 血清状态显示出没有关联。
  
  他表示,我们没有发现统计上的证据支持HSV-2血清阴性或血清阳姓妇女之间使用荷尔蒙避孕药对HIV-1的风险有所不同,而这发现与之前的其它研究认为HSV-2血清阳性之非洲妇女的HIV-1风险增加的论述有所不同;此议题的重要性已经和激增的HSV比率一样重要。
  
  虽然有更多证据支持HSV-2和HIV之间的关联,特别是有关HIV感染个体病毒复制所造成的HSV效果, 但近年来有关OC使用和HIV血清转换之间的关联意见仍是分歧的。
  
  Baeten医师表示,不清楚是否有真正关系存在,但屏障避孕法的双重保护效果是使用荷尔蒙避孕药妇女的目标;研究者现在缩小焦点在机转上,那种荷尔蒙避孕药会增加HIV-1 感受性— 包括阴道上皮构造改变、增加 STI感受性,以及可能往上调节 HIV-1 共同受体。
  
  Baeten医师的世代研究,是一个结束于2003年1月超过10年之大型研究的一部分,共有1,272位 HIV-1血清阴性妇女参与,追踪期平均是456 天,平均年纪是26 岁,参与者每周报告一次平均性伴侣状态;这些妇女中有 74% 的工作是酒吧女侍,纳入试验时有 80%是HSV-2血清阳性;Baeten医师指出,另外有84位在追踪期间转换成 HSV-2;终点时,233 位发生HIV-1;就感染HIV的发生率而论,使用OCs和使用DMPA的妇女之间没有统计上的差异。
  
  北加州大学兼任教授、国际家庭健康中心的资深流行病专家Charles Morrison博士同意,除非研究确定使用避孕药和增加HIV风险之间的关系,否则中到高度风险的妇女仍需采取额外的保护方式。
  
  长期研究避孕方法和性病的Morrison博士表示,服用荷尔蒙避孕药和HIV之间的关系是相互矛盾的,但是对性工作者来说是清楚的,如果性工作者服用口服避孕药,风险是增加的。
  
  根据最近的研究结果,不论他们的分歧,Morrison博士表示,医师必须建议病患有额外的预防;如果妇女使用口服避孕药且长期以来都不是单一性伴侣关系,她们真正需要保险套来双重保护。
  
  Baeten 医师和Morrison 博士报告没有相关财金关系。
  
  国际性病研究学会第17届会议:摘要 049。发表于2007年7月31日。
  

HSV Status Not a Factor in Ora

By Bonnie Darves
Medscape Medical News

August 2, 2007 (Seattle) — The effect of hormonal contraceptive use on the risk of HIV seroconversion does not differ statistically between women who are seronegative or seropositive for herpes simplex virus 2 (HSV-2), a new study has found. Results of the prospective cohort study of 1206 female African sex workers who were HIV-1 seronegative at baseline, presented here at the 17th Meeting of the International Society for Sexually Transmitted Diseases Research, showed that although hormonal contraception with either oral contraceptives (OCs) or long-acting progestins such as depot medroxyprogesterone acetate (DMPA) increases risk of HIV-1 seroconversion, HSV serostatus appeared to have no confounding effect, according to the study's lead author and infectious disease specialist Jared Baeten, MD, PhD, from the University of Washington in Seattle.

"We found no statistical evidence that the effect of hormonal contraception on HIV-1 risk differed between the women who were HSV-2 seropositive and those who were seronegative," he said, adding that the findings differ from those of recent previous studies that found elevated HIV-1 risk among HSV-2 seropositive women in Africa. The issue is increasingly important as rates of HSV skyrocket.

Although growing evidence supports the connection between HSV-2 and HIV, especially with regard to HSV's effect on viral replication in HIV-infected individuals, results regarding the actual association between OC use and HIV seroconversion have been divergent in recent years.

"It's unclear whether a true relationship exists," Dr. Baeten said, "but it is clear that dual protection with barrier methods should be the goal for women using hormonal contraception." Researchers are now focusing more narrowly on the mechanisms by which hormonal contraception might increase HIV-1 susceptibility — including changes in vaginal epithelial structure, increased STI susceptibility, and possibly upregulation of HIV-1 coreceptors.

In Dr. Baeten's cohort study, conducted as part of a larger study over a 10-year period ending in January 2003, a total of 1272 HIV-1 seronegative women were enrolled and followed monthly for a median of 456 days. The median age was 26 years, and participants reported median sexual partner status of 1 per week; 74% of the women were primarily employed as barmaids. Fully 80% were HSV-2 seropositive at enrollment, Dr. Baeten noted, and an additional 84 participants seroconverted to HSV-2 during follow-up. At endpoint, 233 had developed HIV-1. Regarding HIV acquisition incidence, there was no statistical difference between women who used OCs and those who used DMPA.

Charles Morrison, MPH, PhD, a senior epidemiologist at Family Health International and adjunct professor at the University of North Carolina at Chapel Hill, agreed that until future studies define the relationship between contraceptive use and increased HIV risk, women in moderate to high-risk populations should take additional protective measures.

"The take on hormonal contraception and HIV is that the studies have been conflicting. But it's clear that sex workers — if not the general population — are at increased risk if they take oral contraceptives," said Dr. Morrison, who has long studied contraceptive use and sexually transmitted diseases.

On the basis of the results of recent studies, despite their divergence, Dr. Morrison said, treating clinicians should counsel patients to err on the side of additional precaution. "If women are using oral contraceptives and aren't in long-term monogamous relationships, they really need dual protection with condoms."

Dr. Baeten and Dr. Morrison report no relevant financial relationships.

17th Meeting of the International Society for Sexually Transmitted Diseases Research: Abstract 049. Presented July 31, 2007.

    
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