PubMed · 1515844
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D Burgner, P Chetcuti. 1992-07-18. Symptoms after accelerated immunisation.. https://doi.org/10.1136/bmj.305.6846.181-b
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OBJECTIVE: To review the literature and present a summary estimate of the association between HIV-1 acquisition or HIV-1 serostatus and oral contraceptives. DATA SOURCES: MEDLINE database (January 1986-October 1997), AIDSLINE database (January 1980-October 1997), bibliographies of identified articles, and experts in the field of heterosexual HIV transmission. STUDY SELECTION: In all, 591 articles were examined. Twenty-eight studies provided adequate data to calculate a risk estimate for the association of HIV-1 serostatus or HIV-1 seroconversion with oral contraceptives and were selected for inclusion. RESULTS: The overall summary odds ratio (OR) for the association between seroprevalent or seroincident HIV-1 infection and use of oral contraceptives in the 28 studies was 1.19 (95% confidence interval [CI], 0.99-1.42). The summary OR for 21 cross-sectional studies was 1.21 (95% CI, 1.01-1.44), whereas the summary relative risk for seven prospective studies was 1.32 (95% CI, 1.12-1.57). Study quality was assessed by applying a scale reflecting study design, measurement of exposure, ability to assess confounding, and publication status. The summary OR for the eight best studies was 1.60 (95% CI, 1.05-2.44). When analysis was limited to studies conducted in Africa, the summary OR was 1.45 (95% CI, 1.15-1.83) for the 14 studies overall, and 1.65 (95% CI, 1.09-2.52) for the seven best studies. CONCLUSION: This meta-analysis found a significant association between oral contraceptive use and HIV-1 seroprevalence or seroincidence. For women at risk of HIV-1 infection, oral contraceptive use for prevention of pregnancy should be accompanied by condom use for prevention of HIV-1 infection.
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A topic that has received attention in both the statistical and medical literature is the estimation of the probability of failure for endpoints that are subject to competing risks. Despite this, it is not uncommon to see the complement of the Kaplan-Meier estimate used in this setting and interpreted as the probability of failure. If one desires an estimate that can be interpreted in this way, however, the cumulative incidence estimate is the appropriate tool to use in such situations. We believe the more commonly seen representations of the Kaplan-Meier estimate and the cumulative incidence estimate do not lend themselves to easy explanation and understanding of this interpretation. We present, therefore, a representation of each estimate in a manner not ordinarily seen, each representation utilizing the concept of censored observations being 'redistributed to the right.' We feel these allow a more intuitive understanding of each estimate and therefore an appreciation of why the Kaplan-Meier method is inappropriate for estimation purposes in the presence of competing risks, while the cumulative incidence estimate is appropriate.