Smritee Dabee, Christina Balle, Maricianah Onono, Steve Innes, Gonasagrie Nair, Thesla Palanee-Phillips, Adam D Burgener, Steven E Bosinger, Jo-Ann S Passmore, Renee Heffron, Heather Jaspan, Anna-Ursula Happel
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引用次数: 0
摘要
审查目的:醋酸甲羟孕酮长效可逆肌肉注射避孕药(DMPA-IM)被非洲的顺性别妇女广泛使用。虽然 DMPA-IM 能提供可靠的避孕效果,但它对女性生殖道(FGT)粘膜的潜在影响,包括感染 HIV 的风险,引起了人们的关注。本综述总结并比较了观察性队列研究和随机 "艾滋病结果中的避孕选择证据(ECHO)试验 "的证据:尽管之前的观察性研究发现,使用 DMPA-IM 的妇女体内与细菌性阴道病(BV)相关的细菌数量较多、炎症加剧、宫颈阴道 HIV 靶细胞密度增加以及上皮屏障受损,但 ECHO 试验的子研究发现,除了 Th17 样细胞增加外,阴道微生物组、炎症、蛋白质组、转录组以及病毒性和细菌性 STI 风险均未发生不利变化。随机数据表明,使用 DMPA-IM 不会对与感染相关的粘膜终点产生不利影响。这些研究结果支持在感染性传播疾病(包括艾滋病毒)的高风险妇女中安全使用 DMPA-IM。
Update on the Impact of Depot Medroxyprogesterone Acetate on Vaginal Mucosal Endpoints and Relevance to Sexually Transmitted Infections.
Purpose of review: The long-acting reversible intramuscularly-injected contraceptive depot medroxyprogesterone acetate (DMPA-IM) is widely used by cisgender women in Africa. Although DMPA-IM provides reliable contraception, potential effects on the female genital tract (FGT) mucosa have raised concern, including risk of HIV infection. This review summarises and compares evidence from observational cohort studies and the randomised Evidence for Contraceptive Options in HIV Outcomes (ECHO) Trial.
Recent findings: Although previous observational studies found women using DMPA-IM had higher abundance of bacterial vaginosis (BV)-associated bacteria, increased inflammation, increased cervicovaginal HIV target cell density, and epithelial barrier damage, sub-studies of the ECHO Trial found no adverse changes in vaginal microbiome, inflammation, proteome, transcriptome, and risk of viral and bacterial STIs, other than an increase in Th17-like cells. Randomised data suggest that DMPA-IM use does not adversely change mucosal endpoints associated with acquisition of infections. These findings support the safe use of DMPA-IM in women at high risk of acquiring STIs, including HIV.
期刊介绍:
This journal intends to provide clear, insightful, balanced contributions by international experts that review the most important, recently published clinical findings related to the diagnosis, treatment, management, and prevention of HIV/AIDS.
We accomplish this aim by appointing international authorities to serve as Section Editors in key subject areas, such as antiretroviral therapies, behavioral aspects of management, and metabolic complications and comorbidity. Section Editors, in turn, select topics for which leading experts contribute comprehensive review articles that emphasize new developments and recently published papers of major importance, highlighted by annotated reference lists. An international Editorial Board reviews the annual table of contents, suggests articles of special interest to their country/region, and ensures that topics are current and include emerging research. Commentaries from well-known figures in the field are also provided.