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避孕针或令非洲女性患艾滋病风险加倍
2011年10月05日 10:13:02 来源： 新华网
美国研究人员３日发布一项最新研究报告，非洲东部和南部女性广泛使用注射激素避孕药（避孕针），结果感染和传播艾滋病病毒的风险似乎加倍。
不清楚为何会发生这种情况。研究人员认为，可能是避孕针中的孕激素含生物特性，产生生理作用。
有风险
美国华盛顿大学研究人员以博茨瓦纳、肯尼亚、卢旺达、南非、坦桑尼亚、乌干达和赞比亚的３８００对夫妇为研究对象。每对夫妇中，丈夫或妻子一方已感染艾滋病病毒。
报告作者之一、流行病学家和传染病专家贾里德·贝滕说，研究人员跟踪观察多数夫妇大约两年时间，要求他们报告避孕方式，检查先前未感染艾滋病病毒的一方是否被传染。
结果表明，打避孕针女性的艾滋病病毒感染率为人年６.６１％，传染几率是人年２.６１％；相对而言，没有打针者中这两个数字分别为３.７８％和１.５１％。
人年表示人口生存时间长度的复合单位，是人数同生存年数乘积的总和。
研究人员同时发现，口服避孕药似乎也会增加感染和传播艾滋病病毒的风险。但这次研究中因使用口服避孕药的调查对象人数过少，难具统计意义。
研究人员的另一困惑是，怀孕同样可能使女性感染和传播艾滋病病毒风险加倍。他们认为，那可能部分归因于不安全性行为，却同样关联激素。
《柳叶刀传染病》杂志刊登这份报告。
存缺陷
非政府机构“家庭保健国际组织”研究人员查尔斯·莫里森说，先前有至少两项研究表明，避孕针增加女性感染艾滋病病毒风险，但最新研究更具说服力，“我想，它的确提供某些重要证据”。
莫里森同时说，不过，最新研究仍存在一些缺陷，包括所用数据最初并非意在确定使用避孕药与艾滋病病毒之间存在关联，“我想，那可能会让大家对研究结果产生疑问”。
不清楚避孕针为何会增加艾滋病风险。研究人员认为，孕激素似乎有生理作用。
报告另一名作者、流行病学家勒妮·赫夫龙说，研究人员不确定是否是孕激素使女性生殖道组织或阴道黏液发生变化。
赫夫龙说，对猕猴的研究发现，孕激素会使生殖道组织变薄，“但对于女性的研究，没有显现同样结果”。
莫里森说，可能是孕激素引起女性“阴道和子宫的免疫变化”，增加艾滋病病毒的“复制能力”。
贝滕医生说，研究人员曾检测感染艾滋病病毒女性阴道液体中的艾滋病病毒浓度，结果发现“打避孕针的女性阴道液体中含更多艾滋病病毒”，而她们“血液中并没有检测到更多艾滋病病毒”。
需警告？
《纽约时报》报道，尽管最新研究以非洲女性为对象，但研究人员认为，孕激素产生的生理作用可能对所有女性都一样。只不过非洲艾滋病发病率高，更令人担忧。
撒哈拉以南的非洲国家有大约１２００万年龄介于１５岁至４９岁的女性，其中大约６％采取避孕针方式避孕。美国大约３％女性、即１２０万采取这种方式。
世界卫生组织定于明年１月开会，讨论这项研究所提供的证据是否足够充分、是否需要向女性提出警告“使用避孕针可能增加她们感染或传播艾滋病病毒风险”。
世卫组织生殖健康和研究部门的流行病学家玛丽·加菲尔德说：“我们将重新评估世卫组织对避孕剂使用的临床建议。”在这之前，研究人员将复审有关避孕针、女性感染和传播艾滋病病毒风险、女性艾滋病患者使用避孕针可能会加重症状等方面的研究报告。
“我们要确保，只有真正需要警告时我们才发布警告，”她说，“我们不想匆忙作出判断，那可能会对女性的性健康和生殖健康造成严重后果。这是非常困难的窘境。”
按她的说法，“一名女性自己私下便可注射避孕针，无需每天采取避孕措施……同时，避孕针价格相对低廉”。避孕针注射频率通常为每月或３个月一次，实现相当长一段时期内避孕效果。
美国智库“外交学会”官员伊索贝尔·科尔曼说：“如今最佳避孕方式是避孕针，因为大家不需要医生帮助，持久有效，能让女性自己控制避孕时间和调节生育期……如果现在证实这种避孕方式会有助于传播艾滋病，我们将面临严重健康危机。”
一些研究人员认为，没有简单应对方案。部分人主张，应当强调使用安全套。流行病学家卢多·拉夫雷耶说，应探索和推广使用其他避孕方式，例如子宫内避孕器和埋置避孕，“建议停止使用避孕针前，你必须给大家提供别的选择”。（李良勇)
艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复 艾滋病不治会早死，早治才康复
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| 图示∶2011年5月正式出版的《中国特色医疗金鉴》登载的刘君主任及其机构事迹 |
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Injectable contraceptives or make double the risk of AIDS in Africa Women
October 5, 2011 10:13:02 Source: Xinhua
3 U.S. researchers released a new study, women in eastern and southern Africa, widespread use of injected hormonal contraceptives (injectables), the result of HIV infection and the risk of transmission seems to double.
Do not know why this happens. The researchers believe that contraception may be the needle in the progesterone-containing biological properties, resulting in physiological effects.
Risk
University of Washington researchers in Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda and Zambia, 3,800 couples for the study. Each couple, the husband or the wife has been infected with HIV.
One of the report's authors, epidemiologists and infectious disease experts 贾里德贝滕 said the researchers followed for about two years the majority of couples, asking them to report on contraceptive methods, HIV infection has not previously check whether a party has been infected.
The results showed that women fight contraception needle man years of HIV infection 6.61%, chance of infection is person-year 2.61%; In contrast, no injections were in these two figures were 3.78% and 1. 51%.
Person-years survival of the population that the length of time the composite unit, is the product of the number of years with the sum of survival.
The researchers also found that oral contraceptives also appears to increase the spread of HIV infection and the risk. However, this study investigated the use of oral contraceptives number of subjects is too small, difficult to statistically significant.
Another confusion is that researchers, pregnant women infected with the same and may double the risk of HIV transmission. They believe this may be partly attributable to unsafe sex, but also associated with hormones.
"Lancet Infectious Diseases" magazine published the report.
Memory defects
NGO "Family Health International," the researchers said Charles Morrison, at least two previous studies have shown that injectable contraceptives increase the risk of HIV infection in women, but the latest study is more convincing, "I think it does provide some important evidence. "
Morrison also said, however, the latest research there are still some shortcomings, including the use of the data was not initially intended to determine the use of contraceptives and the association between HIV, "I think it may make you question the results of the study."
Injectable contraceptives is not clear why the increase in HIV risk. The researchers believe that progesterone seems to have physiological effects.
Another report author, epidemiologist Lenihefu Long said researchers are unsure whether it is progesterone the female reproductive tract tissues or changes in vaginal mucus.
Huff said the dragon, the monkey studies have found that progesterone causes thinning of genital tissue, "but for women's studies did not show the same results."
Morrison said that progesterone may be caused by women "of the immune changes in the vagina and uterus," to increase the AIDS virus' ability to replicate. "
Betten doctor said, researchers have detected HIV infection in women, vaginal fluid concentrations of HIV, found that "playing the female contraceptive vaginal fluid needle containing more HIV," and they "are not detected in the blood more AIDS virus. "
Take warning?
"The New York Times" reported that, despite the latest study of African women as objects, but the researchers believe that the physiological role of progesterone may be the same for all women. But a high incidence of AIDS in Africa, even more worrying.
Sub-Saharan Africa has about 12 million between the ages of 15 to 49 years old female, about 6% to the needle method of contraception contraception. Approximately 3% of U.S. women, that is 1.2 million to take this approach.
World Health Organization meeting scheduled for January next year to discuss the adequacy of the evidence provided by the Institute fully, the need for a warning to women, "the use of contraceptives may increase their vulnerability to pin or the risk of HIV transmission."
WHO reproductive health and research sectors epidemiologist Mali Jia Rumsfeld said: "We will re-evaluate WHO contraceptive use in clinical recommendations." Prior to this, researchers will review the injectable contraceptives, women infected with and the risk of transmission of HIV, female AIDS patients with symptoms of injectable contraceptives may increase other aspects of the study.
"We want to ensure that only when we really need a warning issued a warning," she said, "We do not want to rush to judge, it may be women's sexual and reproductive health consequences. This is a very difficult dilemma."
According to her statement, "a female contraceptive injection needle can be their own private, without the need to use contraception every day ... ... same time, the injectables are relatively inexpensive." Contraceptive injections frequency is usually once a month or three months, for a long period of time to achieve contraceptive effect.
U.S. think tank, "Institute of Foreign Affairs' officials 伊索贝尔科 Mann said:" Today is the best form of contraception injectable contraceptives, because we do not need medical help, a lasting and effective, allowing women to control their own fertility regulation and contraceptive period of time ... ... If we confirm that this form of contraception will help to spread AIDS, we will face a serious health crisis. "
Some researchers believe that there is no simple response options. Some people claim, it should be emphasized that the use of condoms. Epidemiologist 卢多拉夫雷耶 said, should explore and promote the use of other contraceptive methods such as intrauterine contraceptive devices and embedded, "recommended to stop using contraception before the needle, you must provide a choice for everyone." (Li Liangyong)
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