Craib K J, Meddings D R, Strathdee S A, Hogg R S, Montaner J S, O'Shaughnessy M V, Schechter M T
Vancouver Lymphadenopathy-AIDS Study Group, BC Centre for Excellence in HIV/AIDS, St Paul's Hospital, Canada.
Genitourin Med. 1995 Jun;71(3):150-4. doi: 10.1136/sti.71.3.150.
To determine whether certain sexually transmitted diseases are independent risk factors for HIV transmission in a cohort of homosexual men.
Eligible cases were identified as those who had seroconverted between November 1982 and November 1990. Two persistently HIV-seronegative control participants were randomly selected for each case from all participants who remained seronegative in November 1990. For cases, risk factor data were taken from an index visit which was defined as the first seropositive visit, while for controls these data were obtained from a matched visit which occurred within two months of the index visit for the corresponding case. Mantel-Haenszel methods and logistic regression were used to compare differences in risk factors for seroconversion between cases and controls.
A total of 125 cases and 250 controls were eligible for this study. Cases were significantly more likely to have had reported any gonorrhoea (17% versus 6%; OR = 2.94; 95% CI: 1.51-5.73) or syphilis (7% versus 2%; OR = 3.78; 95% CI: 1.33-10.79) than controls during the seroconversion period. Multivariate logistic regression revealed rectal gonorrhoea to be independently associated with risk of seroconversion (odds ratio = 3.18; p = 0.044), whereas urethral gonorrhoea (p = 0.479) and pharyngeal gonorrhoea (p = 0.434) were not after inclusion of rectal gonorrhoea. In addition, the following variables were also shown to exert an independent effect on seroconversion: frequency of anal intercourse, use of illicit drugs, number of male sexual partners, and lack of a post-secondary education.
In this observational study, rectal gonorrhoea was found to be associated with HIV seroconversion after adjustment for a number of HIV risk factors. We cannot rule out that rectal gonorrhoea was not directly associated with HIV infection but rather with other residual lifestyle factors not fully adjusted for in the analysis. However, the relationship with gonococcal involvement of a specific anatomic site lends support to a biological association between gonorrhoea and HIV infection, rather than to alternative non-biologic explanations. Our findings are consistent with previous studies reporting an association between HIV infection and non-ulcerative sexually transmitted diseases. Such a direct association might be explained by postulating that gonorrhoea results in inflamed rectal mucosa and compromised epithelial integrity, thereby predisposing an individual to subsequent HIV infection.
确定在一组男同性恋者中，某些性传播疾病是否为HIV传播的独立危险因素。
符合条件的病例为那些在1982年11月至1990年11月期间血清学发生阳转的人。从1990年11月仍为血清学阴性的所有参与者中，为每个病例随机选取两名持续HIV血清学阴性的对照参与者。对于病例，危险因素数据取自定义为首次血清学阳性就诊的索引就诊，而对于对照，这些数据是从与相应病例的索引就诊在两个月内发生的匹配就诊中获得的。采用Mantel-Haenszel方法和逻辑回归来比较病例组和对照组之间血清学阳转危险因素的差异。
共有125例病例和250名对照符合本研究条件。在血清学阳转期间，病例报告有任何淋病（17%对6%；比值比=2.94；95%可信区间：1.51-5.73）或梅毒（7%对2%；比值比=3.78；95%可信区间：1.33-10.79）的可能性显著高于对照。多变量逻辑回归显示直肠淋病与血清学阳转风险独立相关（比值比=3.18；p=0.044），而在纳入直肠淋病后，尿道淋病（p=0.479）和咽部淋病（p=0.434）则不然。此外，以下变量也显示对血清学阳转有独立影响：肛交频率、使用非法药物、男性性伴侣数量以及未接受过高等教育。
在这项观察性研究中，在对多种HIV危险因素进行调整后，发现直肠淋病与HIV血清学阳转有关。我们不能排除直肠淋病与HIV感染没有直接关联，而是与分析中未充分调整的其他残留生活方式因素有关。然而，与特定解剖部位的淋球菌感染的关系支持了淋病与HIV感染之间的生物学关联，而不是其他非生物学解释。我们的研究结果与先前报道HIV感染与非溃疡性性传播疾病之间关联的研究一致。这种直接关联可能是通过假设淋病导致直肠黏膜炎症和上皮完整性受损，从而使个体易患随后的HIV感染来解释的。
