Cofactors of Progression to Acquired Immunodeficiency Syndrome in a Cohort of Male Sexual Contacts of Men With Human Immunodeficiency Virus Disease

Abstract

In a cohort of 249 male sexual contacts of men with acquired immunodeficiency syndrome (AIDS) or an AIDS-related condition in Toronto, Ontario, Canada, 143 cohort members were seropositive on enrollment and 16 seroconverted between initial recruitment in July 1984 to July 1985 and December 1988. Data on age, smoking and drinking status, recreational drug use, and history of sexually transmitted diseases and other diseases were obtained from interviews at induction and during follow-up on the cohort members every 3 months. Cox relative risk regression models, in which time was calculated from estimated date of human immunodeficiency virus (HIV) infection for seroprevalent cohort members and from 90 days prior to the first positive test for seroconverters, examined the potential effect of use of a variety of recreational drugs and the occurrence of selected infections on the risk of development of AIDS. Thirty-five cohort members developed AIDS while under study. No significant association with risk of progression to AIDS was noted for use of various recreational drugs (singly or in combination), history of specific infections, age at enrollment, or smoking and drinking status at enrollment. Only estimated duration of HIV infection appeared to be associated with increasing risk of development of AIDS.

Impact of HIV infection and smoking on lung immunity and related disorders

“…It has been suggested that iron and oxidative stress are possible mechanisms of enhanced production of HIV-1 by alveolar macrophages in cigarette smokers [69,70]. In contrast, a number of clinical studies has failed to confirm accelerated disease progression in smokers [71][72][73][74][75][76][77][78], most probably because they were restricted to specific high-risk groups, such as men who have sex with men and injection-drug users. Given that smoking may be correlated with other high-risk sexual or drug use behaviour, these studies are troubled by the possibility of confounding and future studies should seek to include epidemiologically appropriate control groups with comparable risk profiles and a wider spectrum of participants [79].…”

Smoking and the outcome of infection

“…blood levels of Faster fall in CD4 count [118]. AIDS progression, the risk of PCP [74], pneumonia, candidiasis [75,76], leucoplakia [75] h , dementia complex [76] and oral thrush [79] AIDS [75,[77][78][79][80][81], PCP [75,79,82,83], Kaposi's sarcoma, fall in CD4 cells [75], overall risk of opportunistic infections [76] or death [76,79,81] Longitudinal Risk of pneumonia [87], pneumonia amongst those with CD4 counts lower than 200 cells ⁄ mm 3 [119], mortality [87]. Smokers on HAART had poorer viral responses, a greater risk of virological rebound, and poorer immunological response [85].…”

The Impact of Education on Health Knowledge

“…In a more general context, we investigated the correlation between the change in the knowledge question and the change in heavy drinking between the survey years by running a 7 We did not use the question that asks whether smoking one or more packs of cigarettes per day increases the risk of getting AIDS. This is because scientific evidence on the impact of smoking on faster progression to AIDS among HIV-infected individuals is mixed (Coates et al 1990, Nieman et al 1993. Furthermore, the question may have been misinterpreted as the impact of smoking on the risk of HIV infection, which is different from progressions to AIDS, conditional on HIV.…”