Cofactors for HIV disease progression in a cohort of homosexual and bisexual men

To evaluate cofactors for progression of HIV infection, the authors identif ied 370 men with well-defined seroconversion dates and cofactor data among participants in the San Francisco City Clinic Cohort (SFCCC). Postseroconve rsion substance use, sexual behavior, and sexually transmitted diseases wer e assessed using multivariate proportional hazards models. Weekly use of ha llucinogens strongly and independently predicted death (relative hazard [RH ], 2.59; 95% confidence interval [CI], 1.56-4.28), as well as diagnosis of AIDS; weekly cocaine use also predicted mortality. Receptive anal intercour se with ejaculation was independently associated with mortality risk (RH, 1 .45; 95% CI, 1.02-2.04) and AIDS. The associations of accelerated progressi on with weekly use of recreational drugs and unprotected receptive anal int ercourse need to be confirmed in other prospective cohorts.