RECTAL GONORRHEA AS AN INDEPENDENT RISK FACTOR FOR HIV-INFECTION IN A COHORT OF HOMOSEXUAL MEN
RECTAL GONORRHEA AS AN INDEPENDENT RISK FACTOR FOR HIV-INFECTION IN A COHORT OF HOMOSEXUAL MEN
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DOI：
10.1136/sti.71.3.150
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发表时间：
1995-06-01
期刊：
影响因子：
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通讯作者：
SCHECHTER, MT
中科院分区：
文献类型：
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作者：
CRAIB, KJP;MEDDINGS, DR;SCHECHTER, MT
目的-确定某些性传播疾病是否是男性同性恋群体中艾滋病毒传播的独立危险因素。方法——符合条件的病例被确定为在 1982 年 11 月至 1990 年 11 月之间发生血清转化的病例。从 1990 年 11 月仍保持血清阴性的所有参与者中，为每个病例随机选择两名持续 HIV 血清阴性对照参与者。对于病例，危险因素数据取自定义为第一次血清阳性就诊的索引访视，而对于对照，这些数据从相应病例索引访视两个月内发生的匹配访视中获取。 Mantel-Haenszel方法和逻辑回归用于比较病例和对照之间血清转化危险因素的差异。结果-共有125名病例和250名对照符合本研究的条件。在血清转换期间，与对照组相比，病例报告任何淋病（17% vs 6%；OR = 2.94；95% CI：1.51-5.73）或梅毒（7% vs 2%；OR = 3.78；95% CI：1.33-10.79）的可能性明显更高。多变量逻辑回归显示，直肠淋病与血清转化风险独立相关（优势比 = 3.18；P = 0.044），而纳入直肠淋病后，尿道淋病（p = 0.479）和咽部淋病（P = 0.434）则不相关。此外，以下变量也被证明对血清转化具有独立影响：肛交频率、非法药物的使用、男性性伴侣的数量以及缺乏高等教育。 结论——在这项观察性研究中，在调整了一些 HnT 危险因素后，发现直肠淋病与 HIV 血清转化相关。我们不能排除直肠淋病与 HnV 感染没有直接关系，而是与分析中未完全调整的其他残余生活方式因素相关。然而，淋球菌参与特定解剖部位的关系支持了淋病和艾滋病毒感染之间的生物学关联，而不是其他非生物学解释。我们的研究结果与之前报告的艾滋病毒感染与非溃疡性性传播疾病之间的关联的研究一致。这种直接关联可以通过假设淋病导致直肠粘膜发炎和上皮完整性受损，从而使个体易于随后感染艾滋病毒来解释。
Objective-To determine whether certain sexually transmitted diseases are independent risk factors for HIV transmission in a cohort of homosexual men. Methods-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 obtained from a matched visit 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.Results-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.Conclusions-In this observational study, rectal gonorrhoea was found to be associated with HIV seroconversion after adjustment for a number of HnT risk factors. We cannot rule out that rectal gonorrhoea was not directly associated with HnV 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.