Document 0767
 DOCN  M9550767
 TI    Gonorrhea as a risk factor for HIV acquisition.
 DT    9505
 AU    Weir SS; Feldblum PJ; Roddy RE; Zekeng L; Family Health International,
       Research Triangle Park, NC 27709.
 SO    AIDS. 1994 Nov;8(11):1605-8. Unique Identifier : AIDSLINE MED/95151239
 AB    OBJECTIVE: 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 Zaire found a strong
       association between HIV seroconversion and prior gonorrheal infection.
       The objective of this study was to replicate the Zaire 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. METHODS: 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 Zaire, 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. RESULTS: The
       association between gonorrheal infection and subsequent HIV acquisition
       was stronger in Zaire than in Cameroon [crude odds ratios (OR), 6.3
       versus 2.2]. In both the Zaire 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). CONCLUSION: 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.
 DE    Adult  Cameroon/EPIDEMIOLOGY  Case-Control Studies  Cohort Studies
       Comparative Study  Female  Gonorrhea/COMPLICATIONS/*EPIDEMIOLOGY  Human
       HIV Infections/COMPLICATIONS/*EPIDEMIOLOGY/TRANSMISSION  Odds Ratio
       *Prostitution  Risk Factors  Support, U.S. Gov't, Non-P.H.S.
       Zaire/EPIDEMIOLOGY  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).