mBio：特定类型避孕药会增加HIV感染风险！

rentianyixu

近年来，越来越多证据表明可注射避孕药醋酸甲羟孕酮（DMPA）会增加HIV感染风险。近日，一项发表在国际学术期刊mbio上的最新研究为这一现象提供了生物学解释，这一研究可以帮助女性作出更加合理的避孕选择。

在此项研究之前已经有一些研究提出矛盾性观点，一些研究表明DMPA会增加HIV感染风险，而另一些研究则表明不会增加感染风险，但一直没有研究对这两种观点之间的差异作出合理的生物学解释。

在这项研究中，研究人员对来自乌干达和津巴布韦的年龄在18到35岁之间的823名女性的宫颈拭子结果进行了分析，这些女性都在计生诊所登记过并且登记时都为HIV阴性。在这一队列中有大约200名女性后来感染了HIV。参与研究的女性分为三组，一组使用DMPA，一组使用雌激素孕激素口服避孕药，最后一组使用非激素类避孕药。在每一组中，研究人员都将该组健康女性的结果与发生阴道菌群失调或阴道环境受到细菌真菌或寄生虫感染的女性进行对比。

随后，研究人员对服用口服避孕药或接受DMPA注射是否会增加HIV易感性进行了观察，结果表明使用DMPA会导致女性身体发生有害的免疫变化，而特定的阴道感染或阴道菌群失调会加重DMPA对免疫系统的抑制进一步增加HIV感染风险，除此之外，携带特定阴道感染或发生阴道菌群失调同时服用口服避孕药的女性也会增加有害的免疫变化风险。

研究人员最后指出，女性应该多了解一些避孕知识，从而能够作出更加合理的避孕选择，同时男性和女性也都应该对这一研究结果有所了解，共同预防和治疗HIV感染。

doi:10.1128/mBio.00221-15

The Contribution of Cervicovaginal Infections to the Immunomodulatory Effects of Hormonal Contraception

Raina N. Fichorovaa, Pai-Lien Chenb, Charles S. Morrisonb, Gustavo F. Doncelc, Kevin Mendoncaa, Cynthia Kwokb, Tsungai Chipatod, Robert Salatae, Christine Mauck

Particular types of hormonal contraceptives (HCs) and genital tract infections have been independently associated with risk of HIV-1 acquisition. We examined whether immunity in women using injectable depot medroxyprogesterone acetate (DMPA), combined oral contraceptives (COC), or no HCs differs by the presence of cervicovaginal infections. Immune mediators were quantified in cervical swabs from 832 HIV-uninfected reproductive-age Ugandans and Zimbabweans. Bacterial infections and HIV were diagnosed by PCR, genital herpes serostatus by enzyme-linked immunosorbent assay (ELISA), altered microflora by Nugent score, andTrichomonas vaginalis and Candida albicans infection by wet mount. Generalized linear models utilizing Box-Cox-Power transformation examined associations between levels of mediators, infection status, and HCs. In no-HC users,T. vaginalis was associated with broadest spectrum of aberrant immunity (higher interleukin 1β [IL-1β], IL-8, macrophage inflammatory protein 3α [MIP-3α], β-defensin 2 [BD2], and IL-1 receptor antigen [IL-1RA]). In women with a normal Nugent score and no genital infection, compared to the no-HC group, COC users showed higher levels of IL-1β, IL-6, IL-8, and IL-1RA, while DMPA users showed higher levels of RANTES and lower levels of BD2, both associated with HIV seroconversion. These effects of COC were blunted in the presence of gonorrhea, chlamydia, trichomoniasis, candidiasis, and an abnormal Nugent score; however, RANTES was increased among COC users with herpes, chlamydia, and abnormal Nugent scores. The effect of DMPA was exacerbated by lower levels of IL-1RA in gonorrhea, chlamydia, or herpes, SLPI in gonorrhea, and IL-1β, MIP-3α, and IL-1RA/IL1β ratio in trichomoniasis. Thus, the effects of HC on cervical immunity depend on the genital tract microenvironment, and a weakened mucosal barrier against HIV may be a combined resultant of genital tract infections and HC use.