Department of Pathology & Laboratory Medicine, School of Medicine, Emory University, Atlanta, GA, USA.
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
Int J Epidemiol. 2017 Oct 1;46(5):1593-1606. doi: 10.1093/ije/dyx045.
BACKGROUND: Studies have demonstrated the role of ulcerative and non-ulcerative sexually transmitted infections (STI) in HIV transmission/acquisition risk; less is understood about the role of non-specific inflammatory genital abnormalities. METHODS: HIV-discordant heterosexual Zambian couples were enrolled into longitudinal follow-up (1994-2012). Multivariable models estimated the effect of genital ulcers and inflammation in both partners on time-to-HIV transmission within the couple. Population-attributable fractions (PAFs) were calculated. RESULTS: A total of 207 linked infections in women occurred over 2756 couple-years (7.5/100 CY) and 171 in men over 3216 CY (5.3/100 CY). Incident HIV among women was associated with a woman's non-STI genital inflammation (adjusted hazard ratio (aHR) = 1.55; PAF = 8%), bilateral inguinal adenopathy (BIA; aHR = 2.33; PAF = 8%), genital ulceration (aHR = 2.08; PAF = 7%) and the man's STI genital inflammation (aHR = 3.33; PAF = 5%), BIA (aHR = 3.35; PAF = 33%) and genital ulceration (aHR = 1.49; PAF = 9%). Infection among men was associated with a man's BIA (aHR = 4.11; PAF = 22%) and genital ulceration (aHR = 3.44; PAF = 15%) as well as with the woman's non-STI genital inflammation (aHR = 1.92; PAF = 13%) and BIA (aHR = 2.76; PAF = 14%). In HIV-M+F- couples, the man being uncircumcised. with foreskin smegma. was associated with the woman's seroconversion (aHR = 3.16) relative to being circumcised. In F+M- couples, uncircumcised men with BIA had an increased hazard of seroconversion (aHR = 13.03 with smegma and 4.95 without) relative to being circumcised. Self-reporting of symptoms was low for ulcerative and non-ulcerative STIs. CONCLUSIONS: Our findings confirm the role of STIs and highlight the contribution of non-specific genital inflammation to both male-to-female and female-to-male HIV transmission/acquisition risk. Studies are needed to characterize pathogenesis of non-specific inflammation including inguinal adenopathy. A better understanding of genital practices could inform interventions.
背景：研究表明，溃疡性和非溃疡性性传播感染（STI）在 HIV 传播/感染风险中起作用；但对于非特异性炎症性生殖器异常的作用了解较少。
方法：招募了 1994 年至 2012 年期间纵向随访的赞比亚 HIV 不一致的异性恋夫妇。多变量模型估计了伴侣双方的生殖器溃疡和炎症对夫妇内 HIV 传播时间的影响。计算了人群归因分数（PAF）。
结果：在 2756 对女性的夫妇年中，共有 207 例女性相关的 HIV 感染（7.5/100 对年），3216 对男性的感染（5.3/100 对年）。女性的新发 HIV 感染与女性非 STI 生殖器炎症（调整后的危险比（aHR）=1.55；PAF=8%）、双侧腹股沟淋巴结病（BIA；aHR=2.33；PAF=8%）、生殖器溃疡（aHR=2.08；PAF=7%）以及男性的 STI 生殖器炎症（aHR=3.33；PAF=5%）、BIA（aHR=3.35；PAF=33%）和生殖器溃疡（aHR=1.49；PAF=9%）相关。男性的感染与男性的 BIA（aHR=4.11；PAF=22%）和生殖器溃疡（aHR=3.44；PAF=15%）以及女性的非 STI 生殖器炎症（aHR=1.92；PAF=13%）和 BIA（aHR=2.76；PAF=14%）相关。在 HIV-M+F-夫妇中，男性未行包皮环切术，有包皮垢，与女性的血清转化（aHR=3.16）相关，而非行包皮环切术。在 F+M-夫妇中，未行包皮环切术的 BIA 男性与血清转化（有包皮垢时 aHR=13.03，无包皮垢时 aHR=4.95）的风险增加。溃疡性和非溃疡性性传播感染的症状自我报告率较低。
结论：我们的研究结果证实了 STIs 的作用，并强调了非特异性生殖器炎症对男传女和女传男 HIV 传播/感染风险的贡献。需要研究来描述非特异性炎症包括腹股沟淋巴结病的发病机制。更好地了解生殖器的习惯可以为干预措施提供信息。
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