Intramuscular depo-medroxyprogesterone acetate (DMPA-IM) is the most widely used hormonal contraceptive in sub-Saharan Africa. Previous meta-analyses of observational studies found a significant 40%–50% increased risk associated with DMPA-IM use, relative to no contraception or infrequent condom use. This raised substantial concerns, although these studies had important limitations. Consequently, the open-label randomized Evidence for Contraceptive Options and HIV Outcomes trial was conducted, designed primarily to detect a 50% or greater difference in HIV risk between DMPA-IM, the levonorgestrel (LNG) implant, and the copper-intrauterine device. The ECHO study, published in July 2019, concluded that there is no substantial difference in HIV risk among the methods evaluated, and that all three methods are safe and highly effective. In response, the WHO relaxed the Medical Eligibility Criteria for DMPA-IM use among women at high HIV risk in August 2019. However, two of the three comparisons in the ECHO trial could rule out neither a 50% increase nor no change in HIV risk for one contraceptive compared with another. The study had limitations and the results contained considerable uncertainty. They also did not inform on associated HIV risk for any one of the individual methods due to the absence of a control group such as no contraception or only infrequent condom use. The HIV risks associated with LNG implant and copper-IUD relative to no contraception or infrequent condom use are unknown and these cannot be seen as controls, nor did the authors claim them to be. The results will be discussed in the context of their limitations, what they add to the body of work to date on contraception and HIV acquisition, and the implications of the findings and reports thereof for future research and contraceptive choice.

中文翻译：

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注射避孕药 Depo-Medroxyprogesterone Acetate (DMPA-IM) 是否与 HIV 感染风险增加有关？陪审团还在外面。

肌内注射去甲羟孕酮醋酸酯 (DMPA-IM) 是撒哈拉以南非洲地区使用最广泛的激素避孕药。先前对观察性研究的荟萃分析发现，与不避孕或不经常使用安全套相比，使用 DMPA-IM 的风险显着增加了 40%–50%。尽管这些研究有很大的局限性，但这引起了人们的极大关注。因此，开展了开放标签的避孕选择和 HIV 结果证据随机试验，主要旨在检测 DMPA-IM、左炔诺孕酮 (LNG) 植入物和铜宫内节育器之间的 HIV 风险差异 50% 或更大。2019 年 7 月发表的 ECHO 研究得出的结论是，所评估的方法之间的 HIV 风险没有实质性差异，并且所有三种方法都是安全且高效的。作为回应，世卫组织于 2019 年 8 月放宽了在 HIV 高危女性中使用 DMPA-IM 的医疗资格标准。然而，ECHO 试验中的三项比较中的两项不能排除一种避孕药的 HIV 风险增加 50% 或没有变化与另一个相比。该研究存在局限性，结果包含相当大的不确定性。由于缺乏对照组，例如不避孕或仅不经常使用避孕套，他们也没有告知任何一种单独方法的相关艾滋病毒风险。与不避孕或不经常使用避孕套相比，与 LNG 植入和铜 IUD 相关的 HIV 风险尚不清楚，这些不能被视为对照，作者也没有声称它们是对照。结果将在其局限性的背景下进行讨论，