Exploring the relationship between sexually transmitted diseases and HIV acquisition by using different study designs.
Exploring the relationship between sexually transmitted diseases and HIV acquisition by using different study designs.
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DOI：
10.1097/qai.0b013e318195bd2b
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发表时间：
2009-04-15
期刊：
影响因子：
--
通讯作者：
Klausner JD
中科院分区：
文献类型：
--
作者：
Zetola NM;Bernstein KT;Wong E;Louie B;Klausner JD
据推测，性传播疾病（STD）增加了艾滋病毒感染的风险。然而，建立准确的时间关系和控制混杂因素的困难掩盖了这种关系。为了克服先前的方法学缺陷，我们探索了使用不同的研究设计来检查性病和艾滋病毒感染之间的关系。急性HIV感染患者作为病例纳入，并与1）未感染HIV的患者（匹配的病例对照），2）新诊断的慢性HIV感染患者（感染分析），3）既往临床访视时检测HIV阴性的患者（病例交叉）进行比较。我们使用t检验比较性病的平均数量，并使用逻辑回归确定独立相关因素和急性HIV感染的几率。2003年10月至2007年3月，13 662名男男性行为者在弗朗西斯科市性病诊所接受了艾滋病毒感染检测，350人（2.56%）被诊断为艾滋病毒感染。在HIV感染者中，36例（10.3%）被确定为急性。我们发现在12个月内患上性病的几率一直较高，（匹配病例对照，OR 5.2 [2.2-12.6];感染分析，OR 1.4 [1.0-2.0];病例交叉，OR 1.3 [0.5-3.1]）和3个月（匹配病例对照OR 34.5 [4.1-291.3];感染分析OR 2.3 [1.1-4.8];病例交叉OR 1.8 [0.6-5.6]）。我们发现，与未感染HIV的患者相比，并发直肠淋病（17.0 [2.6 - 111.4]，p<0.01）或梅毒（5.8 [1.1 - 32.3]，p=0.04）的患者急性HIV感染的几率更高。在弗朗西斯科市性病诊所的男性中，急性HIV感染与近期或同期的性病有关，特别是直肠淋病。考虑到性病和HIV感染之间的复杂关系，没有单一的设计可以适当地控制所有可能的混杂因素;需要使用互补设计的研究。
It is hypothesized that sexually transmitted diseases (STDs) increase the risk of HIV acquisition. Yet, difficulties establishing an accurate temporal relation and controlling confounders have obscured this relationship. In an attempt to overcome prior methodologic shortcomings, we explored the use of different study designs to examine the relationship between STDs and HIV acquisition. Acutely HIV-infected patients were included as cases and compared to 1) HIV-uninfected patients (matched case-control), 2) newly diagnosed, chronically HIV-infected patients (infected analysis), and 3) themselves at prior clinic visits when they tested HIV-negative (case-crossover). We used t-tests to compare the average number of STDs and logistic regression to determine independent correlates and the odds of acute HIV infection. Between October 2003 and March 2007, 13,662 male patients who had sex with men were tested for HIV infection at San Francisco's municipal STD clinic and 350 (2.56%) HIV infections were diagnosed. Among the HIV-infected patients, 36 (10.3%) cases were identified as acute. We found consistently higher odds of having had an STD within the 12 months (matched case-control, OR 5.2 [2.2-12.6]; infected analysis, OR 1.4 [1.0-2.0]; case-crossover, OR 1.3 [0.5-3.1]) and 3 months (matched case-control, OR 34.5 [4.1-291.3]; infected analysis, OR 2.3 [1.1-4.8]; case-crossover OR 1.8 [0.6-5.6]) prior to HIV testing among acutely HIV-infected patients. We found higher odds of acute HIV infection among patients with concurrent rectal gonorrhea (17.0 [2.6 - 111.4], p<0.01) or syphilis (5.8 [1.1 - 32.3], p=0.04) when compared to those HIV-uninfected. Acute HIV infection was associated with a recent or concurrent STD, particularly rectal gonorrhea, among men at San Francisco's municipal STD clinic. Given the complex relationship between STDs and HIV infection, no single design will appropriately control for all the possible confounders; studies using complementary designs are required.
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