Coplan P M, Gortmaker S, Hernandez-Avila M, Spiegelman D, Uribe-Zuñiga P, Mueller N E
Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA.
Am J Epidemiol. 1996 Nov 1;144(9):817-27. doi: 10.1093/oxfordjournals.aje.a009016.
The objectives of this study were to evaluate the frequency and determinants of rectal bleeding and the association between rectal bleeding and risk of human immunodeficiency virus (HIV) infection among homosexual/ bisexual men in Mexico City. Men who requested anonymous HIV testing at a public clinic in Mexico City and who reported engaging in any homosexual behavior were eligible to participate in this study. Trained staff collected information on demographic factors, sexual behavior, psychological states, and HIV serostatus from all consenting, eligible clients. Logistic regression modeling was used to investigate the independent effect of risk factors among 2,758 men who were tested between June 1991 and December 1992. Bleeding during anal intercourse was a common occurrence: More than one third of the men in the study reported some bleeding, and 8% reported bleeding in half or more of their intercourse episodes. The prevalence of HIV infection among bleeders was 42% as compared with 28% in nonbleeders (p < 0.0001), and the adjusted odds ratio was 1.8 (95% confidence interval (CI) 1.1-2.8) for men who bled in more than half of their anal intercourse episodes relative to nonbleeders. There was a trend of increasing HIV seroprevalence with increasing frequency of rectal bleeding (p = 0.001). Nine percent of all HIV infections and 42% of infections among frequent bleeders were attributable to rectal bleeding. Men who reported both rectal bleeding and anal warts were 3.5 (95% CI 2.1-5.8) times more likely to be HIV-infected in multivariate analysis than men reporting neither rectal bleeding nor anal warts. Determinants of rectal bleeding included older age, more education, more receptive anal intercourse than insertive intercourse, receptive digital-anal contact, anal warts, and genital ulcers. Among men reporting sex with men in Mexico City, rectal bleeding is common. It is an independent risk factor for HIV infection, and warrants attention in acquired immunodeficiency syndrome prevention efforts. Rectal bleeding that results from rupture of anal warts may be an especially effective portal of HIV transmission.
本研究的目的是评估墨西哥城男同性恋者/双性恋男性直肠出血的频率和决定因素，以及直肠出血与人类免疫缺陷病毒（HIV）感染风险之间的关联。在墨西哥城一家公共诊所要求进行匿名HIV检测且报告有任何同性恋行为的男性有资格参与本研究。训练有素的工作人员从所有同意参与且符合条件的客户那里收集了有关人口统计学因素、性行为、心理状态和HIV血清学状态的信息。采用逻辑回归模型研究了1991年6月至1992年12月期间接受检测的2758名男性中危险因素的独立影响。肛交时出血很常见：超过三分之一的研究对象报告有过出血，8%的人报告在一半或更多性交过程中出血。出血者中HIV感染率为42%，而非出血者为28%（p<0.0001），相对于非出血者，在一半以上肛交过程中出血的男性调整后的优势比为1.8（95%置信区间[CI]1.1 - 2.8）。HIV血清阳性率随直肠出血频率增加呈上升趋势（p = 0.001）。所有HIV感染中有9%以及频繁出血者中的42%的感染可归因于直肠出血。在多变量分析中，报告有直肠出血和肛门疣的男性感染HIV的可能性是既无直肠出血也无肛门疣男性的3.5倍（95%CI 2.1 - 5.8）。直肠出血的决定因素包括年龄较大、受教育程度较高、接受肛交多于插入式肛交、接受指肛接触、肛门疣和生殖器溃疡。在墨西哥城报告有男男性行为的男性中，直肠出血很常见。它是HIV感染的一个独立危险因素，在获得性免疫缺陷综合征预防工作中值得关注。由肛门疣破裂导致的直肠出血可能是HIV传播的一个特别有效的途径。
