Muñoz-Pérez M A, Rodriguez-Pichardo A, Camacho Martinez F
Department of Dermatology, Virgen Macarena Hospital, School of Medicine of Sevilla, Spain.
J Eur Acad Dermatol Venereol. 1998 Nov;11(3):221-6.
HIV infection is primarily a sexually transmitted disease (STD), but intravenous drug use (IDU) is the main risk factor for HIV infection in certain areas, including southern Europe. A number of prospective studies of dermatological findings in HIV-1 infected patients have been published, almost all from countries where homosexuality is the main risk factor of HIV infection and without correlation with CD4 cell counts. No STD data is included in those studies.
To determine the incidence of STDs in a cohort of 1161 HIV-1-positive patients from Spain, in the previous medical history and during the prospective study.
We prospectively examined 1161 HIV-1-positive patients for 38 months, 986 men and 175 women. IDU was the risk factor in 74%, while homosexuality was a risk factor in only 9%. CDC stage II was predominant (51%), while stage IV was less frequent (39%). The mean CD4 cell count was 353/mm3. Patients' past and present medical history of STDs was obtained. CD4 cells/mm3 counts were measured at each visit.
Six hundred and eighty-four patients had a past history of STD, whilst new infections were diagnosed in 258 individuals (22%) during the 38-month study. Pediculosis pubis (26%), gonorrhoea (22%), syphilis (13%), genital candida infection (11%) and condyloma acuminatum (10%) were the commonest previous STDs, followed by non-gonococcal urethritis (NGU) (5%), genital herpes (4%) and trichomoniasis (2%). During the 38-month study period and with strong recommendation of condom use for sexual intercourse, condyloma acuminatum (7%), scabies (6%), syphilis (4%) and genital herpes (3%) were commonly diagnosed, followed by gonorrhoea (1.8%), NGU (1.6%), genital candida infection (1.5%), pediculosis pubis (0.6%) and trichomoniasis (0.3%). Only genital herpes had a statistically significant association with advanced stage (P = 5.12 x 10(-6)) and low CD4 cell counts (180 +/- 166 cells/mm3).
Despite the predominance of the IDU factor among our patients, the incidence of STDs in the past medical history was surprisingly high. The incidence of STD during the study was also high, despite the advice of using condoms after the diagnosis of HIV infection. STDs may accelerate the course of HIV infection and be a poor prognostic indicator in these patients. If an HIV-1-positive patient can acquire an STD, he/she can also transmit HIV infection. This indicates that new publicity campaigns are still needed to stop HIV and STDs infection among HIV-positive patients as well as in the general population.
HIV感染主要是一种性传播疾病（STD），但静脉注射吸毒（IDU）是包括南欧在内的某些地区HIV感染的主要危险因素。已经发表了一些关于HIV-1感染患者皮肤学表现的前瞻性研究，几乎所有研究都来自以同性恋为HIV感染主要危险因素的国家，且未与CD4细胞计数相关联。这些研究中未包含STD数据。
确定来自西班牙的1161名HIV-1阳性患者队列中既往病史和前瞻性研究期间STD的发病率。
我们对1161名HIV-1阳性患者进行了38个月的前瞻性检查，其中男性986名，女性175名。74%的患者以IDU为危险因素，而只有9%的患者以同性恋为危险因素。CDC II期最为常见（51%），而IV期较少见（39%）。CD4细胞平均计数为353/mm³。获取了患者既往和当前的STD病史。每次就诊时测量CD4细胞/mm³计数。
684名患者有STD既往史，而在38个月的研究期间，有258人（22%）被诊断为新感染。既往最常见的STD是阴虱病（26%）、淋病（22%）、梅毒（13%）、生殖器念珠菌感染（11%）和尖锐湿疣（10%），其次是非淋菌性尿道炎（NGU）（5%）、生殖器疱疹（4%）和滴虫病（2%）。在38个月的研究期间，尽管强烈建议性交时使用避孕套，但仍常见诊断出尖锐湿疣（7%）、疥疮（6%）、梅毒（4%）和生殖器疱疹（3%），其次是淋病（1.8%）、NGU（1.6%）、生殖器念珠菌感染（1.5%）、阴虱病（0.6%）和滴虫病（0.3%）。只有生殖器疱疹与晚期（P = 5.12 x 10⁻⁶）和低CD4细胞计数（180 ± 166细胞/mm³）有统计学显著关联。
尽管我们的患者中IDU因素占主导，但既往病史中STD的发病率高得出奇。尽管在诊断HIV感染后建议使用避孕套，但研究期间STD的发病率仍然很高。STD可能会加速HIV感染进程，并且是这些患者预后不良的指标。如果一名HIV-1阳性患者能够感染STD，那么他/她也可能传播HIV感染。这表明仍需要开展新的宣传活动，以阻止HIV阳性患者以及普通人群中的HIV和STD感染。
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