Archibald C P, Schechter M T, Craib K J, Le T N, Douglas B, Willoughby B, O'Shaughnessy M
Vancouver Lymphadenopathy-AIDS Study Group, St. Paul's Hospital, B.C. Canada.
J Acquir Immune Defic Syndr (1988). 1990;3 Suppl 1:S18-23.
In our ongoing cohort study of homosexual men, the ratio of new Kaposi's sarcoma (KS) cases to new opportunistic infections (OI) during the periods 1982-1985, 1986-1987, and 1988-1989 fell from 0.75 (9 KS: 12 OI) to 0.57 (12 KS:21 OI) to 0.27 (4 KS:15 OI), respectively. To examine factors associated with the development of KS as compared to OI, we compared antecedent risk factors in 25 KS cases and 48 OI "controls." In univariate analyses, several classical HIV risk factors including numbers of sexual partners and receptive anal intercourse were higher in the KS than the OI group. The strongest associations were found with an elevated number of sex partners in high-risk areas (San Francisco, Los Angeles, and New York) in the 5 years prior to enrollment and with elevated use of nitrite inhalants. Logistic regression revealed the latter two variables and an elevated number of partners contacted in washrooms/parks to be significant, independent risk factors for KS relative to OI. Any or all of these variables could be related with early HIV infection. However, the association with early sexual contact in high-risk areas raises the more intriguing possibility that this variable is an indicator of an increased exposure either to a particular strain of HIV that is more pathogenic for KS, or, more likely, to a sexually transmitted KS cofactor that may have been more highly concentrated in these areas at this early point in the epidemic. The present study supports an independent association with use of nitrite inhalants, which could be hypothesized either to have an independent biologic effect on KS or to enhance the efficiency of transmission of the cofactor virus.
在我们对男同性恋者进行的一项正在进行的队列研究中，1982 - 1985年、1986 - 1987年以及1988 - 1989年期间，新发卡波西肉瘤（KS）病例与新发性机会性感染（OI）的比例分别从0.75（9例KS：12例OI）降至0.57（12例KS：21例OI），再降至0.27（4例KS：15例OI）。为了研究与KS发生相比OI发生的相关因素，我们比较了25例KS病例和48例OI“对照”的既往危险因素。在单因素分析中，包括性伴侣数量和接受肛交在内的几个经典HIV危险因素在KS组中高于OI组。在入组前5年，在高危地区（旧金山、洛杉矶和纽约）性伴侣数量增加以及亚硝酸盐吸入剂使用增加与KS的关联最为强烈。逻辑回归显示，后两个变量以及在洗手间/公园接触的伴侣数量增加是相对于OI而言KS的显著独立危险因素。这些变量中的任何一个或全部都可能与早期HIV感染有关。然而，与高危地区早期性接触的关联引发了一种更有趣的可能性，即该变量表明要么接触了对KS更具致病性的特定HIV毒株，要么更有可能接触了在疫情早期可能在这些地区更为集中的性传播KS辅助因子。本研究支持与亚硝酸盐吸入剂的独立关联，这可以假设为要么对KS有独立的生物学效应，要么增强辅助因子病毒的传播效率。
