Simonsen J N, Cameron D W, Gakinya M N, Ndinya-Achola J O, D'Costa L J, Karasira P, Cheang M, Ronald A R, Piot P, Plummer F A
Department of Medical Microbiology, University of Nairobi, Kenya.
N Engl J Med. 1988 Aug 4;319(5):274-8. doi: 10.1056/NEJM198808043190504.
Heterosexual transmission of the human immunodeficiency virus (HIV) appears to occur readily in Africa but less commonly in North America and Europe. We conducted a case-control study among men attending a clinic for sexually transmitted diseases in Nairobi to determine the prevalence of HIV infection and the risk factors involved. HIV antibody was detected in 11.2 percent of 340 men who enrolled in the study. Reports of nonvaginal heterosexual intercourse and homosexuality were notably rare. Recent injections and blood transfusions were not associated with HIV infection. Travel and frequent contact with prostitutes were associated with HIV seropositivity. Men who were uncircumcised were more likely to have HIV infection (odds ratio, 2.7; P = 0.003), as were those who reported a history of genital ulcers (odds ratio, 7.2; P less than 0.001). A current diagnosis of genital ulcers was also associated with HIV seropositivity (odds ratio, 2.0; P = 0.028). Multivariate analysis revealed an independent association of genital ulcers with HIV infection in both circumcised and uncircumcised men. Uncircumcised men were more frequently infected with HIV, regardless of a history of genital ulcers. Our study finds that genital ulcers and an intact foreskin are associated with HIV infection in men with a sexually transmitted disease. Genital ulcers may increase men's susceptibility to HIV, or they may increase the infectivity of women infected with HIV. The intact foreskin may operate to increase the susceptibility to HIV.
人类免疫缺陷病毒（HIV）的异性传播在非洲似乎很容易发生，但在北美和欧洲则不太常见。我们在内罗毕一家性传播疾病诊所对前来就诊的男性进行了一项病例对照研究，以确定HIV感染的患病率及相关危险因素。在参与研究的340名男性中，11.2%检测出HIV抗体。非阴道异性性交和同性恋的报告极为罕见。近期注射和输血与HIV感染无关。旅行和频繁接触妓女与HIV血清阳性有关。未行包皮环切术的男性感染HIV的可能性更大（比值比为2.7；P = 0.003），有生殖器溃疡病史的男性也是如此（比值比为7.2；P<0.001）。目前诊断为生殖器溃疡也与HIV血清阳性有关（比值比为2.0；P = 0.028）。多变量分析显示，无论是否行包皮环切术，生殖器溃疡与HIV感染均存在独立关联。无论有无生殖器溃疡病史，未行包皮环切术的男性感染HIV的频率更高。我们的研究发现，生殖器溃疡和完整的包皮与患有性传播疾病的男性的HIV感染有关。生殖器溃疡可能会增加男性对HIV的易感性，或者可能会增加感染HIV的女性的传染性。完整的包皮可能会增加对HIV的易感性。
