Weir S S, Feldblum P J, Roddy R E, Zekeng L
Family Health International, Research Triangle Park, NC 27709.
AIDS. 1994 Nov;8(11):1605-8. doi: 10.1097/00002030-199411000-00013.
The role of gonorrhea in facilitating acquisition of HIV infection has only recently been studied. A previous nested case-control analysis in a cohort of female sex workers in Zaïre found a strong association between HIV seroconversion and prior gonorrheal infection. The objective of this study was to replicate the Zaïre study analysis in a cohort of 273 Cameroonian sex workers to determine whether gonorrhea increased the risk of HIV acquisition, and if the crude association between gonorrheal infection and HIV acquisition was weakened when the level of unprotected coitus was more carefully controlled.
We conducted a nested case-control study of initially HIV-1-negative women (n = 273) followed prospectively (with monthly sexually transmitted disease check-ups and 3-monthly HIV-1 serology). As in Zaïre, cases (seroconverters, n = 17) were compared with controls (women who remained HIV-1-negative, n = 68) for incidence of gonorrhea and sexual exposure during the presumed period of HIV-1 acquisition.
The association between gonorrheal infection and subsequent HIV acquisition was stronger in Zaïre than in Cameroon [crude odds ratios (OR), 6.3 versus 2.2]. In both the Zaïre and Cameroon data the crude OR were reduced (6.3 to 4.8, and 2.2 to 1.7, respectively) by controlling for risk factors including a dichotomous variable indicating irregular or no condom use. When this variable was replaced in the Cameroon data with a more precise continuous variable indicating the percentage of unprotected coital acts, the gonorrhea OR was further reduced to 1.4 (95% confidence interval, 0.4-4.9).
These results suggest that in the Cameroon cohort, gonorrheal infection did not facilitate HIV acquisition, but that having gonorrhea was a marker for unprotected coitus that facilitated HIV acquisition. The data demonstrate how OR can be overestimated when imprecise dichotomous measures of unprotected coitus are used. Future studies should plan for better control of self-reported condom use.
淋病在促进艾滋病病毒感染方面的作用直到最近才得到研究。先前在扎伊尔一组女性性工作者中进行的巢式病例对照分析发现，艾滋病病毒血清转化与先前的淋病感染之间存在密切关联。本研究的目的是在一组273名喀麦隆性工作者中重复扎伊尔的研究分析，以确定淋病是否会增加感染艾滋病病毒的风险，以及当更严格地控制无保护性交水平时，淋病感染与艾滋病病毒感染之间的粗略关联是否会减弱。
我们对最初为艾滋病病毒1型阴性的女性（n = 273）进行了一项巢式病例对照研究，并进行前瞻性随访（每月进行性传播疾病检查，每3个月进行艾滋病病毒1型血清学检查）。与扎伊尔的研究一样，将病例（血清转化者，n = 17）与对照（仍为艾滋病病毒1型阴性的女性，n = 68）在假定的艾滋病病毒1型感染期间的淋病发病率和性接触情况进行比较。
淋病感染与随后的艾滋病病毒感染之间的关联在扎伊尔比在喀麦隆更强[粗略比值比（OR），分别为6.3和2.2]。在扎伊尔和喀麦隆的数据中，通过控制包括一个表明不规律或未使用避孕套的二分变量在内的危险因素，粗略OR均有所降低（分别从6.3降至4.8和从2.2降至1.7）。当喀麦隆数据中的这个变量被一个更精确的连续变量（表明无保护性交行为的百分比）取代时，淋病的OR进一步降至1.4（95%置信区间，0.4 - 4.9）。
这些结果表明，在喀麦隆队列中，淋病感染并未促进艾滋病病毒的感染，但患有淋病是无保护性交的一个标志，而无保护性交促进了艾滋病病毒的感染。数据表明，当使用不精确的无保护性交二分测量方法时，OR可能会被高估。未来的研究应更好地控制自我报告的避孕套使用情况。
