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PubMed1989

Testicular atrophy in homosexual AIDS patients: an immune-mediated phenomenon?

An immunopathologic analysis of the testes of 20 homosexual acquired immune deficiency syndrome (AIDS) patients was performed to investigate the hypothesis that the testicular atrophy of these patients represents an immune-mediated process. The findings were compared to those in a control group of heterosexual men without AIDS. The testes of the homosexual AIDS patients showed an overall lower degree of spermatogenesis with more prominent interstitial inflammation and thickening of the tubular basement membrane. However, direct immunofluorescence and immunoperoxidase studies failed to demonstrate significant differences in the prevalence of immune complex deposits along the tubular basement membrane in the two study groups. No electron-dense deposits were demonstrated in cases examined ultrastructurally. Therefore, this study does not support the hypothesis that the testicular atrophy of homosexual AIDS patients is a manifestation of autoimmune orchitis. Further studies are needed to elucidate the pathogenesis of the testicular atrophy in AIDS, as this appears to be a specific manifestation of the disease.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Peripheral blood mononuclear cell abnormalities and their relationship to clinical course in homosexual men with HIV infection.

Quantitative abnormalities of leukocyte subpopulations have been shown to correlate with clinical status in human immunodeficiency virus (HIV) infection. We have performed peripheral blood leukocyte phenotyping in 23 HIV-seropositive homosexual men, and correlated the results with clinical follow-up information. Individuals with CD4+ greater than 400/mm3 (Group 1) had less severe abnormalities in other mononuclear cell subpopulations than patients with CD4+ less than 400/mm3 (Group 2). Group 1 had decreased CD4+CDw29+ (B-cell inducer) cells, compared to HIV-seronegative homosexual controls, with normal CD4+CD45R+ (suppressor-inducer) cells, suggesting that CD4+ subpopulations are reduced at different rates. Group 2 had decreased counts for both CD4+CDw29+ and CD4+CD45R+ cells. Both groups had increased cytotoxic T cells (CD8+CD11b-), with decreased B cells and CD4+/CD8+ ratios, compared to HIV-seronegative homosexual controls. The Group 2 patients with subsequent clinical deterioration had particularly low CD4+ cells, CD4+CD45R+ cells, CD2+Ta1+ cells, and CD4+/CD8+ ratios and high CD8+CD11b- cells, compared to those with clinically stable illness. Our findings suggest that specific leukocyte subpopulations are altered differentially at various stages of HIV infection. However, the study involved only quantitative measurements of specific T- and B-cell subsets with no attempt to measure in vitro function. It is of course possible that normal numbers of cells in these subpopulations might be functionally deficient.

Antigens, Differentiation↗
PubMed1992

Risk of Kaposi's sarcoma and sexual practices associated with faecal contact in homosexual or bisexual men with AIDS.

The causal agent of Kaposi's sarcoma is unknown. That the disorder is ten times more common in homosexual or bisexual men with the acquired immunodeficiency syndrome (AIDS) than in other human immunodeficiency virus (HIV) transmission groups suggests that a certain aspect of their behaviour exposes them to the agent or facilitates its spread. We therefore assessed social and demographic characteristics, including sexual behaviour, of 65 homosexual or bisexual men with AIDS from London. Sexual practices in which there was contact with partner's faeces before AIDS developed were the main determinants of Kaposi's sarcoma risk. Risk increased with frequency of insertive "rimming" (oral-anal contact): Kaposi's sarcoma developed in 18% of the men with AIDS who reported never having practised insertive rimming compared with 50% who practised it less than once a month, 73% between once a week and once a month, and 75% or more once a week (two-sided exact p-value for trend less than 0.001). 45 men had been interviewed about their sexual practices before AIDS developed, and 20 were interviewed at the time the syndrome developed. The findings were similar and statistically significant when each group was analysed separately. The men with Kaposi's sarcoma also tended to be more sexually active and were more likely to engage in other sexual activities that entailed contact with faeces than were the men who had other features of AIDS only. Other behaviours and exposures, including the use of "poppers" (nitrite inhalants), were not related to Kaposi's sarcoma risk, after taking into account whether the subjects had practised insertive rimming. The data suggest that faecal-oral contact is the main route of transmission of the agent of Kaposi's sarcoma in homosexual or bisexual men with AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1985

Chromosome aberrations in peripheral lymphocytes of male homosexuals.

Karyotypes of peripheral lymphocytes of 19 male homosexuals showed increased hypodiploidy. Chromosomes #19 and #20 were most frequently lost. Also, structural chromosome aberrations frequently occurred consisting chiefly of translocations and simple chromosome breaks. Terminal deletions, inversions, and isochromosomes occurred less commonly. In three of the cases, 100% of the cells were involved in a pericentric inversion of a chromosome #9. Chromosomes #3 in p21.1 and 1 in p32.3 were repeatedly affected. Structural aberrations were seen less frequently in men with acquired immunodeficiency syndrome(AIDS) and AIDS-related complex than in asymptomatic homosexuals. The hypodiploidy with preferential loss of chromosomes was constantly present. The marker chromosomes and simple breaks at repeated sites are another manifestation of damage to the immune system in these male homosexuals from Greenwich Village in New York City. The chromosomal damage was potentially the result of exposure to amyl and butyl nitrites, viral infections, or immunologic reactions to sperm, which crossreact with lymphocytes.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Immunoreconstitution of T-cell impairments in asymptomatic male homosexuals by thymic humoral factor (THF).

The feasibility of using Thymic Humoral Factor (THF) for immunomodulation in asymptomatic male homosexuals was evaluated in a study on fifteen subjects with T-cell impairments, selected on the basis of a 2SD reduction in T helper/inducer (T4+) cells and one additional lymphocytic defect. Following two biweekly courses of treatment, mean relative increments of T4+ (P less than 0.002), T3+ (P less than 0.02) and total lymphocyte (P less than 0.05) populations of the group receiving THF (n = 7) were significantly increased when compared to the placebo group (n = 8). In addition, a transient increase in T4+ lymphocytes was observed after the first course in the two individuals of the THF-treated group who were seropositive for HTLV-III/LAV but not in those who were seronegative. No difference was found between the groups in fluctuations of serum interferon (IFN) or proliferation of peripheral mononuclear cells to mitogens. The results of this limited trial demonstrate that THF is capable of correcting T-cell impairments that may predispose asymptomatic homosexuals to infection by HTLV-III, without affecting IFN production. These findings suggest that future strategies for AIDS prevention in high-risk groups should include institution of large controlled trials in immunodeficient, asymptomatic, HTLV-III/LAV-seronegative male homosexuals to study the potential of selective immunoreconstitution as a preventive measure against HTLV-III/LAV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Theoretical perspectives accounting for adolescent homosexuality.

Few topics in sexology elicit such a diversity of opinions and emotions as the question of etiology of homosexuality. Views frequently carry with them implicit or explicit messages concerning the psychologic health of this sexual orientation. Theories of sexual development usually portray adolescence as a critical time in the life course because of changes in: 1) anatomy and physiology; 2) psychologic functioning: the reawakening, renewal, and reliving of previously established sexual relations and drives; and/or 3) social conditions: an increased exposure and adherence to societal messages concerning appropriate and inappropriate social and sexual behaviors and relationships. This paper provides a brief overview of several major theories--evolutionary biology, psychoanalysis, and social processes--as they relate to the development of sexual orientation. In addition, an ethologic perspective that synthesizes various etiologic theories, as they relate to homosexuality during adolescence, is briefly reviewed. In these discussions, the issue of whether homosexuality is a normal or abnormal developmental state during adolescence is also addressed.

Adolescent↗
PubMed1993

Sperm competition and the persistence of genes for male homosexuality.

Homosexuality is increasingly recognized as having a genetic component. Why then does it persist, when common sense suggests that it should result in fewer offspring? Monozygotic-twin studies permit a rough estimate of the importance of genetics (70%) in the development of male homosexuality, and the proportion of homosexuals remains constant: Fisher's Theorem then tells us there is an advantage to the heterozygote, which we find need be no greater than 2%. Behavior and sperm competition suggest what this advantage might be.

Bisexuality↗
PubMed2004

Quantitative and theoretical analyses of the relation between older brothers and homosexuality in men.

Meta-analysis of aggregate data from 14 samples representing 10,143 male subjects shows that homosexuality in human males is predicted by higher numbers of older brothers, but not by higher numbers of older sisters, younger brothers, or younger sisters. The relation between number of older brothers and sexual orientation holds only for males. This phenomenon has therefore been called the fraternal birth order effect. Research on birth order, birth weight, and sexual orientation suggests that the developmental pathway to homosexuality initiated by older brothers operates during prenatal life. Calculations assuming a causal relation between older brothers and sexual orientation have estimated the proportion of homosexual men who owe their sexual orientation to fraternal birth order at 15% in one study and 29% in another. The maternal immune hypothesis proposes that the fraternal birth order effect reflects the progressive immunization of some mothers to male-specific antigens by each succeeding male fetus and the increasing effects of such immunization on sexual differentiation of the brain in each succeeding male fetus. There are at least three possible mechanisms by which the mother's immune response could influence the fetus: the transfer of anti-male antibodies across the placenta from the maternal into the fetal compartment, the transfer of maternal cytokines across the placenta, and maternal immune reactions affecting the placenta itself. This hypothesis is consistent with recent studies showing that the quantity of fetal cells that enter the maternal circulation is greater than previously thought, and that the number of male-specific proteins encoded by Y-chromosome genes is greater than previously thought.

Antigens↗
PubMed2000

Cost-effectiveness of screening for anal squamous intraepithelial lesions and anal cancer in human immunodeficiency virus-negative homosexual and bisexual men.

PURPOSE: Homosexual and bisexual men are at an increased risk for human papillomavirus-induced squamous intraepithelial lesions and cancer of the anus. Our objective was to estimate the cost-effectiveness of screening for anal squamous intraepithelial lesions in these high-risk patients. SUBJECTS AND METHODS: A Markov model was developed to evaluate alternative screening strategies using anal cytology in a hypothetical cohort of homosexual and bisexual men. Data were obtained from prospective cohort studies, national databases, Medicare reimbursement rates, and the published literature. Model outcomes included life expectancy, quality-adjusted life expectancy, total lifetime costs, and incremental cost-effectiveness ratios. RESULTS: The undiscounted life expectancy gain associated with anal cytology screening every 3 years was 5.5 months. Compared with no screening, screening every 3 years increased the discounted quality-adjusted life expectancy by 1.8 months and cost $7,000 per quality-adjusted life year (QALY) gained. Screening every 2 years cost $15,100 per QALY gained compared with screening every 3 years. Annual screening provided incremental benefits of less than 0.5 quality-adjusted months and had an incremental cost of $34,800 per QALY gained. Screening every 6 months provided little additional benefit (i.e, 5 days) over that of annual screening and had an incremental cost of $143,500 per QALY gained. CONCLUSION: In homosexual and bisexual men, screening every 2 or 3 years for anal squamous intraepithelial lesions with anal cytology would provide life-expectancy benefits comparable with other accepted preventive health measures, and would be cost-effective.

Adult↗
PubMed1991

Hand preference in homosexual men.

The present study examined the distribution of hand preference and its relationship to immune system functioning and performance on neuropsychological tests in a sample of 993 homosexual men from the Multicenter AIDS Cohort Study comprising 502 HIV-1 seronegatives, 436 asymptomatic HIV-1 seropositives, and 55 men with diagnoses of AIDS or AIDS Related Complex. The prevalence of left-handedness in all of the groups (13.1-14.5%) was consistent with prior published reports of prevalent left-handedness in the general population. The distribution of hand preference scores (on a 5-item self-report questionnaire) was J-shaped and shifted to the right as in the general population. There were no differences between right- and left-handers in the immune system parameter of CD4 counts, nor was there any increase of self-reported allergies among the left-handers. We found a significantly larger number of 'outliers' on the neuropsychological measures for left-handers than for right-handers, both for HIV-1 seronegatives and seropositives. These results failed to replicate Lindesay's (1987) report of a leftward shift in manual preference among homosexual men, and failed to support Geschwind and Galaburda's (1985b) hypothesis of a link between homosexuality, handedness and autoimmune disorder. The differences between right- and left-handers on neuropsychological measures, independent of HIV-1 serostatus, are discussed in terms of Satz's (1972) model of pathological left-handedness.

Adult↗
PubMed1990

Fundamental issues in the care of homosexual youth.

The development of a homosexual identity spans the entire life cycle, but adolescence is a critical period in the lives of gay and lesbian persons. Various pre- and postnatal biologic and environmental factors are thought to determine sexual orientation early in life. An emerging homosexual identity may be reflected in youths' sexual attractions, fantasies, and cultural affiliations, as well as their behaviors. The adolescent experiences of homosexual persons profoundly affect health outcomes. The goals of care are to promote normal adolescent development, social and emotional well-being, and physical health. Comprehensive and coordinated educational, mental health, social, and medical services are recommended.

Adolescent↗
PubMed1986

The clinical approach to the male homosexual patient.

A history of sexual orientation, practices, and life styles, a complete review of organ systems, and a thorough physical examination are unique but essential elements of the examination of homosexual men. Laboratory screening should take into account the incubation period for infections, the risk for infection based on sexual practices, and cost. Physicians should counsel homosexual men about all aspects of a healthy life style; for this advice to be accepted, however, physicians must develop a relation with their homosexual patients that is based on awareness, expertise, and mutual understanding.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Medical students' attitudes toward AIDS, homosexual, and intravenous drug-abusing patients: a re-evaluation in New York City.

After completing their clinical rotations, 69% of the third-year medical school class at Columbia University responded to a survey based on one originally used by Kelly et al. at the University of Mississippi, to determine their attitudes toward acquired immunodeficiency syndrome (AIDS) patients, homosexual men, and intravenous drug abusers (IVDAs). Results of this study were compared to the findings of Kelly et al. to determine how, if at all, geographic and environmental exposures affected student attitudes. Unlike the University of Mississippi students, who exhibited a highly negative and prejudiced view of homosexuals and patients with AIDS, Columbia students displayed no evidence of negative attitude toward homosexuals and a much less harsh judgment of AIDS patients. They, however, did have dramatically negative attitudes toward IVDAs; 78.4% stated that they strongly disliked and would avoid this group of patients. There is a complex multi-variable environmental effect on students' attitudes during medical school. It is not possible to generalize attitudes from one medical school to another. The necessity of incorporating activities into student education to evaluate and to reduce prejudice is discussed.

Acquired Immunodeficiency Syndrome↗
PubMed1984

Distribution of T-cell phenotypic subsets and surface immunoglobulin-bearing lymphocytes in lymph nodes from male homosexuals with persistent generalized adenopathy: an immunohistochemical and ultrastructural study.

Lymph nodes from homosexual men with persistent generalized adenopathy were evaluated for distribution of T-cell phenotypic subsets and surface immunoglobulin(SIg)-bearing lymphocytes. Electron microscopy revealed tubulovesicular structures within lymphocytes but no multivesicular rosettes. Eight to 33 per cent of the lymphocytes within germinal centers were suppressor T cells, compared with germinal centers from control lymph nodes, in which these cells were rare (P = 0.002). Significantly greater percentage of suppressor/cytotoxic T lymphocytes were also present in the paracortex and follicular mantles of lymph nodes from the homosexual group (P = 0.002 and 0.007, respectively). Percentages of helper T lymphocytes were significantly decreased in germinal centers (P = 0.008) and paracortical regions (P = 0.002). Florid follicular hyperplasia with aberrations in follicular architecture was the most common histologic pattern, but one node with diffuse hyperplasia and subtotal effacement of architecture revealed depletion of SIg-bearing lymphocytes and increased numbers of suppressor T cells. Reversed helper-to-suppressor T-cell ratios in lymph nodes from homosexuals with generalized adenopathy may be related to viral infection and contribute to immune deficiency in this group.

Adult↗
PubMed1986

Is Entamoeba histolytica in homosexual men a pathogen?

Entamoeba histolytica (EH) in homosexual men is generally considered to be pathogenic. To test this hypothesis, the generally accepted features of invasion (haematophagous trophozoites in faeces; high-titre serum antibody; moderate to severe acute inflammatory change; and presence of EH in the mucosa on rectal biopsy) and the zymodeme pattern of cultured trophozoites were assessed in twenty-three EH excretors and eleven control homosexual men. No trophozoites or antibody to EH were found in either group. When other pathogens were excluded, no patient in either group had severe, acute histopathological proctitis. Moderately severe change was seen in 38% of EH excretors and 18% of controls (not significant). All the zymodemes were non-pathogenic. Successful eradication of EH did not result in even a trend towards normalisation of the moderate inflammatory histopathology. There are, therefore, no data here to suggest that EH is a pathogen in homosexual men.

Adult↗
PubMed1987

Risk factors for seroconversion to human immunodeficiency virus among male homosexuals. Results from the Multicenter AIDS Cohort Study.

2507 homosexual men who were seronegative for human immunodeficiency virus (HIV) at enrollment were followed for six months to elucidate risk factors for seroconversion to HIV. 95 (3.8%) seroconverted. Of men who did not engage in receptive anal intercourse within six months before baseline and in the six-month follow-up period, only 0.5% (3/646) seroconverted to HIV. By contrast, of men who engaged in receptive anal intercourse with two or more partners during each of these successive six-month intervals, 10.6% (58/548) seroconverted. No HIV seroconversions occurred in 220 homosexual men who did not practise receptive or insertive anal intercourse within twelve months before the follow-up visit. On multivariate analysis receptive anal intercourse was the only significant risk factor for seroconversion to HIV, the risk ratio increasing from 3-fold for one partner to 18-fold for five or more partners. Furthermore, data for the two successive six-month periods show that men who reduced or stopped the practice of receptive anal intercourse significantly lowered their risk of seroconversion to 3.2% and 1.8%, respectively. Receptive anal intercourse accounted for nearly all new HIV infections among the homosexual men enrolled in this study, and the hazards of this practice need to be emphasised in community educational projects.

Acquired Immunodeficiency Syndrome↗
PubMed1982

Immunosuppression in a homosexual man with Kaposi's sarcoma.

The occurrence of Kaposi's sarcoma in young homosexual men is a recently reported condition. The same individuals are at risk for the development of Pneumocystis carinii pneumonia and other unusual infections. These associations suggest these persons are somehow immunocompromised. Evidence of current or prior cytomegalovirus (CMV) infection is seen in a high percentage of these and other homosexual men. CMV infections are known to induce alterations in the immunoregulatory suppressor and helper T lymphocyte populations. The CMV infection is suspect as the cause of immunosuppression in these individuals. We present a case of Kaposi's sarcoma in a homosexual men with CMV cultured from his urine and semen. He showed a marked increase in his suppressor/cytotoxic cell (OKT8-positive) population, as well as a marked decrease in his helper cell (OKT4-positive) population. Mitogen and antigen studies demonstrated absent or markedly diminished response both in vitro and in vivo. Pokeweed mitogen (PWM)-induced IgG synthesis appeared normal. This patient, as well as the majority of other reported patients with this disease, manifested the HLA-Dr5 phenotype. The immunosuppression in this patient and possibly other similar men appears to be mediated by abnormalities in the immunoregulatory T lymphocytes.

Adult↗
PubMed1985

Medical problems of the homosexual adolescent.

Physicians treating adolescents should take a complete sexual history, including sexual orientation and practices, to determine whether their patients are homosexually active. Lesbians are at very low risk for sexually transmitted diseases, but they do have other health concerns. Four general groups of conditions may be encountered in homosexually active men: classical sexually transmitted diseases (gonorrhea, infections with Chlamydia trachomatis, syphilis, herpes simplex infections, genital warts, pubic lice, scabies); enteric diseases (infections with Shigella species, Campylobacter jejuni, Entamoeba histolytica, Giardia lamblia, hepatitis A, hepatitis B, hepatitis non-A, non-B, and cytomegalovirus); trauma (fecal incontinence, hemorrhoids, anal fissure, foreign bodies, rectosigmoid tears, allergic proctitis, penile edema, chemical sinusitis, inhaled nitrite burns, and sexual assault of the male patient); and the acquired immunodeficiency syndrome (AIDS). Clinicians can assist homosexual teenagers by understanding their special health needs, by counseling them about safe sexual practices, and by accepting their relationships nonjudgmentally.

Acquired Immunodeficiency Syndrome↗