Access to effective affordable contraception is critical for individual and public health. A wide range of hormonal contraceptives (HCs), which differ in composition, concentration of the progestin component, frequency of dosage, and method of administration, is currently available globally. However, the options are rather limited in settings with restricted economic resources that frequently overlap with areas of high HIV-1 prevalence. The predominant contraceptive used in sub-Saharan Africa is the progestin-only three-monthly injectable depot medroxyprogesterone acetate. Determination of whether HCs affect HIV-1 acquisition has been hampered by behavioral differences potentially confounding clinical observational data. Meta-analysis of these studies shows a significant association between depot medroxyprogesterone acetate use and increased risk of HIV-1 acquisition, raising important concerns. No association was found for combined oral contraceptives containing levonorgestrel, nor for the two-monthly injectable contraceptive norethisterone enanthate, although data for norethisterone enanthate are limited. Susceptibility to HIV-1 and other sexually transmitted infections may, however, be dependent on the type of progestin present in the formulation. Several underlying biological mechanisms that may mediate the effect of HCs on HIV-1 and other sexually transmitted infection acquisition have been identified in clinical, animal, and ex vivo studies. A substantial gap exists in the translation of basic research into clinical practice and public health policy. To bridge this gap, we review the current knowledge of underlying mechanisms and biological effects of commonly used progestins. The review sheds light on issues critical for an informed choice of progestins for the identification of safe, effective, acceptable, and affordable contraceptive methods.

中文翻译：

---

激素避孕和HIV-1获取：生物学机制

获得有效的负担得起的避孕方法对于个人和公共卫生至关重要。目前，全球范围内可获得范围广泛的各种激素避孕药（HCs），其成分，孕激素成分的浓度，给药频率和给药方法各不相同。但是，在经济资源有限的情况下，这些选择相当有限，而这些资源往往与HIV-1流行高发地区重叠。在撒哈拉以南非洲地区使用的主要避孕药是仅孕激素的三个月注射剂甲羟孕酮醋酸盐。行为差异可能阻碍了对HCs是否影响HIV-1采集的确定，这可能会混淆临床观察数据。对这些研究的荟萃分析表明，使用醋酸甲羟孕酮库与使用HIV-1的风险增加之间存在显着关联，这引起了人们的关注。虽然炔诺孕酮庚酸酯的数据有限，但未发现含有左炔诺孕酮的联合口服避孕药或两个月一次可注射的避孕药炔诺酮庚酸酯的相关性。但是，对HIV-1和其他性传播感染的易感性可能取决于制剂中孕激素的类型。在临床，动物和动物医学​​领域，已经发现了几种可能介导HCs对HIV-1和其他性传播感染获得影响的潜在生物学机制。尽管炔诺酮庚酸酯的数据有限，但两个月一次的避孕药炔诺酮庚酸酯的注射量也没有。但是，对HIV-1和其他性传播感染的易感性可能取决于制剂中孕激素的类型。在临床，动物和动物医学​​领域，已经发现了几种可能介导HCs对HIV-1和其他性传播感染获得影响的潜在生物学机制。尽管炔诺孕酮庚酸酯的数据有限，但两个月一次的避孕药炔诺孕酮庚酸酯的注射量也没有。但是，对HIV-1和其他性传播感染的易感性可能取决于制剂中孕激素的类型。在临床，动物和动物医学​​领域，已经发现了几种可能介导HCs对HIV-1和其他性传播感染获得影响的潜在生物学机制。离体研究。在将基础研究转化为临床实践和公共卫生政策方面存在很大差距。为了弥合这一差距，我们回顾了常用孕激素的潜在机制和生物学效应的最新知识。审查揭示了在知情地选择孕激素以鉴定安全，有效，可接受和负担得起的避孕方法时至关重要的问题。