Ciesielski Carol A.
Chicago Department of Health, 530 E. 31st Street, 2nd Floor, Chicago, IL 60616, USA.
Curr Infect Dis Rep. 2003 Apr;5(2):145-152. doi: 10.1007/s11908-003-0051-5.
The introduction of highly active antiretroviral therapy (HAART) has led to dramatic reductions in morbidity and mortality due to HIV infection. However, the resulting optimism and improved health status produced by HAART appears to have contributed to unanticipated consequences in men who have sex with men (MSM): loss of fear of acquiring and transmitting HIV, an increase in high-risk sex, decreased use of condoms, and a resurgence of gonorrhea and syphilis. Other factors, such as lack of knowledge of sexually transmitted diseases (STDs), use of the Internet as a venue to find sex partners, the increasing use of Viagra (Pfizer, New York, NY) as a recreational drug, and the apparent expanding role of oral sex in STD transmission are fueling these trends. Since ulcerative and inflammatory STDs facilitate HIV transmission, a new wave of HIV infection in MSM may be on the horizon. The rising STD rates and relapses in high-risk sexual behaviors in MSM, both HIV-infected and -uninfected MSM, have profound implications for public health and the clinical management of these patients. Clinicians should be aware of this turn of events, and implement new screening and counseling guidelines that have been issued in response to these alarming reports.
高效抗逆转录病毒疗法（HAART）的引入已使因感染艾滋病毒导致的发病率和死亡率大幅降低。然而，HAART带来的乐观情绪和健康状况改善似乎在男男性行为者（MSM）中产生了意想不到的后果：对感染和传播艾滋病毒的恐惧消失、高危性行为增加、避孕套使用减少，以及淋病和梅毒的再度流行。其他因素，如对性传播疾病（STD）缺乏了解、利用互联网寻找性伴侣、越来越多地将伟哥（辉瑞公司，纽约，纽约）用作消遣性药物，以及口交在性传播疾病传播中日益凸显的作用，都在助长这些趋势。由于溃疡性和炎症性性传播疾病会促进艾滋病毒传播，男男性行为者中可能即将出现新一轮艾滋病毒感染。无论是感染艾滋病毒还是未感染艾滋病毒的男男性行为者，性传播疾病发病率上升以及高危性行为复发，都对公共卫生和这些患者的临床管理产生深远影响。临床医生应意识到这一情况的变化，并实施针对这些令人担忧的报告而发布的新筛查和咨询指南。
