Disease manifestation among homosexual men with acquired immunodeficiency syndrome: a possible role of nitrites in Kaposi's sarcoma.

To identify risk factors that determine the major manifestations of the acquired immunodeficiency syndrome (AIDS), the authors analyzed data from three epidemiologic studies conducted by the Centers for Disease Control. The authors compared patients by outcome of disease. Eighty-seven homosexual patients (47 with Kaposi's sarcoma, 20 with Pneumocystis carinii pneumonia, and 20 with both) had participated in the earlier studies, and their interviews and laboratory test results were available. Compared with patients who have Pneumocystis carinii pneumonia only, patients with Kaposi's sarcoma and those with both diseases reported more different sexual partners, more recreational drug use, higher incomes and higher rates of non-B hepatitis. Multivariate analysis showed that the variable most strongly associated with Kaposi's sarcoma was the use of large quantities of nitrite inhalants. A multifactorial model is postulated to explain the various disease manifestations of AIDS. This study suggests that the use of nitrite inhalants may be a cofactor in the development of Kaposi's sarcoma. By identifying other cofactors, investigators may be able to define additional opportunities for prevention of the development of AIDS.