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PubMed1983

Severe acquired immune deficiency syndrome in male homosexuals: diminished capacity to make interferon-alpha in vitro associated with severe opportunistic infections.

Natural killer cell function, directed against either K562 tumor targets or herpes simplex virus type 1-infected fibroblasts, was often low in patients with acquired immune deficiency syndrome (AIDS) but failed to distinguish these patients from either male homosexual controls or patients with lymphadenopathy. Mononuclear cells from patients with AIDS and opportunistic infections generated diminished levels of interferon-alpha in response to herpes simplex virus type 1-infected fibroblasts. This deficiency discriminated patients with severe opportunistic infections from most individuals with either generalized lymphadenopathy or Kaposi's sarcoma only and from male homosexual control subjects. The deficiency in interferon-alpha generation may be the consequence of the opportunistic infections that these individuals have contracted or may be a direct manifestation of AIDS itself.

Acquired Immunodeficiency Syndrome↗
PubMed1986

Potential value of rectal-screening cultures for Chlamydia trachomatis in homosexual men.

We compared the potential value of rectal-screening cultures for Chlamydia trachomatis and Neisseria gonorrhoeae among homosexual men attending a sexually transmitted disease clinic and also assessed the relation of either infection to patient age, symptoms, history of previous infection, and likelihood of early treatment. Of 1,429 homosexual men cultured over a six-month period, 118 (8%) had gonococcal rectal infection, 72 (5%) had chlamydial rectal infection, and 15 (1%) had both. The prevalence of rectal chlamydial infection was strongly related to age, with the highest occurrence in adolescents. C. trachomatis was isolated more often from men infected with N. gonorrhoeae (11%) than from men not infected with N. gonorrhoeae (5%; P = .01), and simultaneous urethral infection in patients with positive rectal cultures occurred more frequently in men infected with N. gonorrhoeae than in men infected with C. trachomatis (27% vs. 14%, respectively; P = .05). The majority of rectal infections with N. gonorrhoeae and C. trachomatis in this population were asymptomatic. Although 80% of the patients who had rectal infection with N. gonorrhoeae were appropriately treated on the initial clinic visit, only 18% of those with rectal chlamydial infections received proper treatment (P less than .0001). The yield of patients who were newly identified and brought to treatment was 4.8 patients per 100 screening cultures for C. trachomatis vs. 1.9 patients per 100 screening cultures for N. gonorrhoeae.

Adolescent↗
PubMed1987

Effects of human immunodeficiency virus on the cellular immune response to Epstein-Barr virus in homosexual men: characterization of the cytotoxic response and lymphokine production.

We investigated Epstein-Barr virus (EBV)-specific T cell responses in homosexual men with, and at risk for, AIDS. We studied healthy laboratory workers, healthy homosexual men, and patients with AIDS-related complex or AIDS. The cytotoxic activity, absolute number of T4 lymphocytes, and interleukin-2 (IL-2) production decreased, whereas the relative number of Ia+ lymphocytes increased with the extent of infection with the human immunodeficiency virus (HIV). Cytotoxic activity correlated positively with the number of T4 lymphocytes (r = .56, P less than .001) and the amount of IL-2 produced (r = .47, P less than .01) but not with interferon production. Recombinant IL-2, but not gamma interferon, could restore cytotoxic T cell activity to control levels in patients with early HIV infection. EBV-specific serological studies paralleled the T lymphocyte investigations. The increased EBV activity observed in progressive HIV infection may be related to a diminution in the auto-reactive population of the T4 lymphocyte subset and may be amenable to IL-2 reconstitution.

AIDS-Related Complex↗
PubMed1989

Enhanced antibody responses to Epstein-Barr virus in HIV-infected homosexual men.

We investigated the association between human immunodeficiency virus (HIV) and Epstein-Barr virus (EBV) infections in 593 homosexual men. The status of EBV infection in this group was evaluated based on serological evidence of EBV-specific antibody responses. The geometric mean titers (GMT) of antibody to EBV capsid antigen (EBV-VCA) (1:154) and EBV early antigen (EA) (1:16) in 141 HIV-seropositive men were significantly higher than respective titers in 452 HIV seronegative men (1:95 and 1:12). Antibody titers to EBV were higher in HIV-infected men with lymphadenopathy than in asymptomatic HIV-seropositive men. However, these correlation were less evident in patients with AIDS-related complex. Elevated antibody titers to EBV were found to be independent of levels of total serum IgG. Cytomegalovirus (CMV) antibody titers were also found to be significantly increased among HIV-seropositive men, independent of total IgG. Antibody titers to EBV were not correlated with those to CMV in either HIV-seronegative or HIV-seropositive men. Subjects without evidence of HIV infection, but who had high antibody titers to EBV-VCA and EBV-EA, had elevated mean numbers of CD3+, CD4+, and CD8+ cells, and lower levels of CD4+/CD8+ cell ratios compared to subjects with low EBV-antibody titers. This study suggests that the elevated levels of circulating antibodies against EBV in homosexual men are associated with loss of control of latent EBV due to HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Lack of detection of human immunodeficiency virus in persistently seronegative homosexual men with high or medium risks for infection.

Some studies have suggested that seronegative homosexual men who have practiced high-risk sexual behavior can carry the human immunodeficiency virus (HIV) in a silent state, detectable only by polymerase chain reaction (PCR) or selective viral culture. To assess this concept, blood specimens were studied from 59 homosexual men with recognized risk behaviors: unprotected anal receptive intercourse at least once and many lifetime sex partners. After extensive virologic studies and PCR analysis, only one virus-positive, antibody-negative individual was identified. These findings indicate that HIV virus-positive, seronegative individuals are rare.

Adult↗
PubMed1993

Comparison of risk factors for hepatitis C and hepatitis B virus infection in homosexual men.

Serum samples from 735 homosexual or bisexual men were tested for antibodies to hepatitis C virus (HCV) and serologic markers of hepatitis B virus (HBV), and risk factors for each infection were compared. Thirty-four (4.6%) were confirmed HCV-positive compared with 81% positive for one or more HBV serologic marker(s). History of intravenous drug use (IVDU) and blood transfusion were significantly associated with HCV positivity (odds ratio [OR] = 14.3 and 4.4, respectively), but neither was significantly associated with HBV positivity. Sexual behavior was significantly associated with infection with both viruses. When IVDU and blood transfusion were controlled for, HCV infection was marginally associated with > 50 sex partners/year (OR = 2.1), > 25 oral receptive partners (OR = 2.4), and > 25 anal receptive partners (OR = 1.9). HBV infection was more strongly associated with the same variables. HCV infection is uncommon in homosexual men and IVDU is the primary route of transmission, but sexual transmission also occurs, albeit infrequently.

Adult↗
PubMed1993

The association between circumcision status and human immunodeficiency virus infection among homosexual men.

To evaluate whether uncircumcised status is correlated with acquisition of human immunodeficiency virus (HIV), 502 homosexual men were surveyed; 85% were circumcised. HIV infection was significantly associated with uncircumcised status (odds ratio [OR], 2.2; 95% confidence interval [CI], 1.2, 3.8), nonwhite race, intravenous drug use, sexual contact with an intravenous drug user, number of male partners, frequency of unprotected receptive anal intercourse, and with history of genital herpes, anal herpes, or syphilis. Uncircumcised status was significantly associated with older age, nonwhite race, and history of syphilis; it was inversely associated with intravenous drug use. Using logistic regression analysis, the adjusted OR for the association between HIV infection and uncircumcised status was 2.0 (95% CI, 1.0, 4.0). Uncircumcised homosexual men had 2-fold increased risk of HIV infection. The role of circumcision as an intervention strategy to reduce sexual transmission of HIV warrants consideration.

Adolescent↗
PubMed1995

The predictive value of T cell function in vitro and pre-AIDS zidovudine use for survival after AIDS diagnosis in a cohort of homosexual men in Amsterdam.

The best independent predictors of survival after AIDS diagnosis were determined in 160 homosexual men from the Amsterdam Cohort Study (1987 CDC case definition). In a Cox model, all pre-AIDS laboratory markers gathered during follow-up in the study did not independently predict survival after AIDS. A second analysis, using data available only at AIDS diagnosis, revealed that T cell reactivity after stimulation with phytohemagglutinin and monoclonal CD3 antibodies and the CD4+ cell count at diagnosis were independent predictors of survival. In an interval-based Cox model, the predictive value of pre-AIDS zidovudine use was determined. One year after AIDS diagnosis, participants with pre-AIDS zidovudine use had a worse survival probability (relative hazard = 3.99). In conclusion, the survival probability of homosexual men with AIDS can be estimate adequately using information obtained at clinical AIDS diagnosis. Analysis revealed the important predictive value of T cell function tests in vitro.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Feasibility of human immunodeficiency virus vaccine trials in homosexual men in the United States: risk behavior, seroincidence, and willingness to participate.

Human immunodeficiency virus (HIV)-seronegative high-risk homosexual men were enrolled in a vaccine feasibility study in three US cities. HIV seroincidence was 2.3/100 person-years (95% confidence interval [CI], 1.7-2.9) over 18 months in 1975 men. After receiving an explanation of HIV vaccine trial design, 37% stated they were "definitely" willing to participate in future trials; seroincidence was 3.7/100 person-years (95% CI, 2.5-4.9) in this subgroup. An additional 57% "might be" or were "probably" willing. Independent predictors of HIV seroconversion in multivariable pooled logistic regression analysis were having a known HIV-seropositive sex partner (odds ratio [OR], 4.5; 95% CI, 2.6-7.8), injection drug use (OR, 3.6; 95% CI, 1.2-10.7), unprotected receptive anal sex (OR, 2.4; 95% CI, 1.4-4.2), condom failure (OR, 2.4; 95% CI, 1.4-4.1), gonococcal/nongonococcal urethritis (OR, 2.3; 95% CI, 1.1-4.7), and age < 25 years (OR, 2.2; 95% CI, 1.2-4.2). Interest in vaccine trials and seroincidence in high-risk homosexual men are sufficiently high to initiate efficacy trials once a suitable candidate vaccine is identified. Risk factors for seroconversion highlight important area for development of ancillary intervention strategies.

AIDS Vaccines↗
PubMed1996

Increased incidence of cancer among homosexual men, New York City and San Francisco, 1978-1990.

Several studies have shown that human immunodeficiency virus type 1 (HIV-1) is associated with an increase in the incidence of Kaposi's sarcoma and non-Hodgkin's lymphoma among homosexual men. The role of HIV-1 in increasing the incidence of other malignancies is more controversial. The incidence of non-Kaposi's sarcoma cancer was examined from 1978 to 1990 among 15,565 homosexual men who participated in studies of hepatitis B virus infection in the late 1970s in New York City, New York, and San Francisco, California. The standardized incidence ratio (SIR) for all cancers was 1.6 (95% confidence interval (CI) 1.4-1.8). Excesses were observed for non-Hodgkin's lymphoma (SIR = 12.7; 95% CI 11.0-14.6). Hodgkin's disease (SIR = 2.5; 95% CI 1.5-3.9), and anal cancer (SIR = 24.2 95% CI 13.5-39.9). As seen with non-Hodgkin's lymphoma, a cancer known to be associated with HIV-1. Hodgkin's disease incidence was significantly higher in more recent years compared with earlier years. No cases of Hodgkin's disease were found among HIV-1 antibody-negative men, and Hodgkin's disease was diagnosed near the time of initial acquired immunodeficiency syndrome diagnoses. Anal cancer incidence did not correlate with HIV-1 antibody status and did not tend to occur near the time of AIDS diagnoses. This study confirms the association of non-Hodgkin's lymphoma with HIV-1 infect on and suggests an association between Hodgkin's disease and HIV-1 infection. An excess in anal cancer was observed but did not appear to be associated with HIV-1 infection.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Risk factors for human herpesvirus 8 seropositivity and seroconversion in a cohort of homosexual men.

Sexual and nonsexual modes of transmission of human herpesvirus 8 (HHV8) have been suggested, but specific routes remain unclear. Therefore, the objective of this study was to assess risk factors for HHV8 seropositivity and determine specific sexual practices associated with HHV8 seroconversion. Sera from 1,458 homosexual men (Amsterdam Cohort Study, 1984-1996) were tested for antibodies to HHV8 with a modified version of an enzyme immunoassay, using recombinant HHV8 lytic phase capsid (ORF65) and latent phase nuclear (ORF73) proteins. HHV8 seroprevalence at study entry was 20.9% (305/1,458); was highest among those with positive human immunodeficiency virus (HIV) status, no steady partner, and southern European or Latin American nationality; and increased with older age and higher number of sexual partners. During follow-up, 215 men seroconverted for HHV8 (incidence: 3.6/100 person-years). Both prevalence and incidence rates remained more or less stable during the study period. Orogenital insertive sex (odds ratio (OR) = 5.95; 95% confidence interval (CI): 2.88, 12.29) or orogenital receptive sex (OR = 4.29; 95% CI: 2.11, 8.71) with more than five partners in the past 6 months, older age (OR = 2.89; 95% CI: 1.13, 7.34, when older than 45 years), and preceding HIV infection (OR = 2.47; 95% CI: 1.53, 3.99) were independent predictors for HHV8 seroconversion. The authors found strong evidence for orogenital transmission of HHV8 among homosexual men.

Adult↗
PubMed1980

Comparative prevalence rates of sexually transmitted diseases in heterosexual and homosexual men.

This study compared prevalence rates of most common sexually transmitted diseases (STD) in heterosexual and homosexual men who made respectively 12,201 and 5324 visits to an STD clinic over 18 months. Overall, homosexual men were significantly (p < 0.001) more likely than heterosexual men to have gonorrhea (30.31% vs. 19.83%), early syphilis (1.08% vs. 0.34%) and anal warts (2.90% vs. 0.26%) but less likely to have nongonococcal urethritis (NGU) (14.63% vs. 36.40%, p < 0.001), herpes genitalis (0.93% vs. 3.65%, p < 0.001), pediculosis pubis (4.30% vs. 5.35%, p < 0.005), scabies (0.42% vs. 0.76%, p < 0.02), and genital warts (1.68% vs. 6.69%, p < 0.001). In most cases the differences in rates remained significant (p < 0.05) when corrected for age and race. It is speculated that higher rates of gonorrhea and syphilis result from a larger mean number of sexual contacts, more potential sites of infection, and more hidden and asymptomatic disease, while the lower rates of the other STD result from a lesser susceptibility of anal mucosa to the causative agent(s) of NGU, herpes genitalis, and venereal warts or from a lack of pubic apposition (pediculosis pubis).

Adult↗
PubMed1989

Acquired immunodeficiency syndrome (AIDS)-free time after human immunodeficiency virus type 1 (HIV-1) seroconversion in homosexual men. Multicenter AIDS Cohort Study Group.

To estimate the time interval between human immunodeficiency virus type 1 (HIV-1) seroconversion and acquired immunodeficiency syndrome (AIDS) diagnosis in homosexual men, prospective incident cohorts are difficult to obtain and, if assembled, provide few events owing to the long incubation time. Although seroprevalent cohorts are numerous in size and events, the information is limited due to the unknown times since seroconversion. To combine the information provided by 1,628 seroprevalent men (304 AIDS cases) and 233 seroconverters (12 AIDS cases) being followed in a multicenter study since 1984, the postseroconversion changes in hematologic variables occurring in the incident cohort were used to develop a model that allowed for the imputation of the unknown times since seroconversion for the seroprevalent cohort. Nonparametric life table methods incorporating truncation and censoring were applied for the estimation of the probability distribution of the AIDS-free time after seroconversion. The precision of the estimates was evaluated using bootstrap methods. The analysis suggested that AIDS is unlikely (less than 0.5%) in the first year; 78% of seropositive homosexual men remain AIDS-free 60 months after seroconversion; and the AIDS incidence increases for months 12-36 and levels off at 38 per 1,000 person-semesters for months 42-60. The nonparametric estimate of the incidence rate suggests a median AIDS-free time of 11 years, which is longer than previous estimates based on parametric models.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Kaposi's sarcoma in a cohort of homosexual and bisexual men. Epidemiology and analysis for cofactors.

Acquired immunodeficiency syndrome (AIDS) surveillance data for both the United States and San Francisco indicate that Kaposi's sarcoma is more common in homosexual and bisexual men with AIDS than in other adults with AIDS, and that the proportion of newly diagnosed AIDS cases presenting with Kaposi's sarcoma has been significantly declining over time. The changing epidemiology of Kaposi's sarcoma was analyzed in a well-characterized cohort of homosexual and bisexual men; laboratory and interview data from a sample of these men were evaluated for determinants of and cofactors associated with Kaposi's sarcoma. Among 1,341 men with AIDS, the proportion presenting with Kaposi's sarcoma declined from 79% in 1981 to 25% in 1989. Compared with other men with AIDS, men with Kaposi's sarcoma had a shorter interval from human immunodeficiency virus (HIV) seroconversion to AIDS diagnosis (median, 77 vs. 86 months). Men with and without Kaposi's sarcoma did not significantly differ with respect to number of sexual partners, history of certain sexually transmitted or enteric diseases, use of certain recreational drugs (including nitrite inhalants), or participation in certain specific sexual practices. The decline in Kaposi's sarcoma may at least partly be due to a shorter latency period from infection to disease. Although cofactors for the development of Kaposi's sarcoma may exist, many previously hypothesized agents were not supported by this analysis.

Acquired Immunodeficiency Syndrome↗
PubMed1991

Estimating the 1978-1990 and future spread of human immunodeficiency virus type 1 in subgroups of homosexual men.

The authors studied the historical spread of human immunodeficiency virus type 1 (HIV-1) infection in homosexual/bisexual men and projected its future spread in these men using data from an AIDS-free cohort recruited during late 1984 in Baltimore, Maryland; Chicago, Illinois; Los Angeles, California; and Pittsburgh, Pennsylvania. Dates of preentry seroconversion in HIV-1 seroprevalent men were estimated using study entry values of hematologic variables influenced by HIV-1 infection. The authors used survival methods incorporating truncation to determine numbers/dates of seroconversion for men with a pre-1984 AIDS diagnosis who were selectively excluded by design from the 1984 AIDS-free cohort. Overall, the annual seroconversion hazard rose progressively from 0.4% in 1978 to 13.8% in 1983, dropped to 4.6% in 1985, and remained relatively stable at 1.1-2.2% from 1986 to 1990. By January 1990, almost 46% of men who were seronegative in 1978 had seroconverted. The authors estimated historical rates of spread by city, age, education, and ethnicity to examine the effects of these factors in the early and continuing stages of the HIV-1 epidemic. There were striking differences among cities with respect to pre-1985 seroconversion rates but not with respect to post-1985 seroconversion rates. Age, education, and ethnicity were all associated with 1978-1990 seroconversion rates. Future seroconversion among homosexual men was predicted assuming that the "stabilized" 1986-1990 hazards (stratified by age) observed here will be representative of future rates. Truncated Kaplan-Meier methods gave the probability of a seronegative 20-year-old man's remaining seronegative in subsequent years. Such a man has a 20.2% chance of seroconverting before reaching the age of 25 years (a 4.4% yearly hazard). The annual hazard drops to 2.5% between 25 and 30 years, to about 1.5% between 30 and 45 years, and to 1.0% between 45 and 55 years. The overall probability of seroconversion prior to age 55 years is about 50%, with seroconversion still continuing at and after age 55. Given that this cohort consists of volunteers receiving extensive anti-HIV-1 transmission education, the future seroconversion rates of the general homosexual population may be even higher than those observed here.

Adult↗
PubMed1992

Corroboration of sexual histories among male homosexual couples.

Using data from a study of human immunodeficiency virus transmission among homosexual male partners from Boston, Massachusetts, the authors compared self-reported sexual histories among 155 index-partner pairs during 1985-1988. Overall, high levels of agreement were observed for all reported sexual activities. Agreement on anal sex was very high (Spearman's r = 0.78-0.79, p less than or equal to 0.001; kappa = 0.76-0.88, p less than or equal to 0.001). Level of agreement did vary significantly by a couple's drug and alcohol use; the heavier substance user generally reported fewer sexual encounters than the lighter user. These results have important implications in sexual behavior research and show that among homosexual men, self-reports of sexual behavior may be reasonably valid.

Acquired Immunodeficiency Syndrome↗
PubMed1992

Estimation of the acquired immunodeficiency syndrome incubation period in intravenous drug users: a comparison with male homosexuals.

Estimates of the risk of developing acquired immunodeficiency syndrome (AIDS) have been limited to studies involving homosexual men, transfusion recipients, and hemophiliac subjects. Little is known, however, about the natural history of the human immunodeficiency virus infection in intravenous drug users. An Italian multicenter cohort study of 420 individuals who seroconverted between 1982 and 1990 provided the opportunity to study the incubation period to AIDS in this group. A three-state Markov model was fitted to the data, and estimates of the risk of developing AIDS were obtained for intravenous drug users, male homosexuals, and three age groups. The risk of developing AIDS increased significantly with age. The estimated annual risk of developing AIDS for individuals between 25 and 34 years of age and over 35 years was 2.4 and 3.8 times higher, respectively, than that observed for individuals between 16 and 24 years of age. The mode of transmission did appear to have a small but not statistically significant influence on the time interval between the diagnosis of AIDS-related conditions and AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed1994

Emerging patterns of heart disease in HIV infected homosexual subjects with and without opportunistic infections; a prospective colour flow Doppler echocardiographic study.

We studied 124 homosexual men aged 36.7 +/- 7.6 years (range 23-57) using Doppler echocardiography. One hundred and one patients (Group A) had had acquired immunodeficiency syndrome for 1.6 +/- 1.0 years and 23 patients (Group B) had had HIV infection without opportunistic infections for 3.2 +/- 2.3 years. Doppler echocardiography was normal in 31% of Group A patients and in 61% of Group B. Pericardial effusion was found in 44 Group A patients (44%) and two Group B patients (9%). In Group A, left ventricular dilatation and/or dysfunction were found in 20 patients (20%), aortic root dilatation and regurgitation in eight patients (8%) and an intracardiac echogenic mass in seven patients (7%); in Group B one patient (4%) had an intracardiac mass. Forty-four (44%) Group A patients had cardiac presentations, and of these 22 had cardiomegaly with clinical signs of heart failure; 10 patients had tachyarrhythmias compared to only two in Group B. Although the CD4 lymphocyte count (%) was significantly lower in Group A than in Group B (5.4 +/- 6.1 vs 13.3 +/- 7.3, P < 0.001), the presence of pericardial effusion, left ventricular dysfunction, right-sided cardiac enlargement or the duration of HIV infection, did not relate to the CD4 level in either group. Although often not diagnosed clinically, cardiac involvement in patients with AIDS is a clinical reality, with pericardial effusion, cardiomyopathy and left ventricular dysfunction appearing to have a high prevalence in male homosexual patients with AIDS. These clinical and echocardiographic findings are associated with clinically apparent intercurrent opportunistic infections, rather than the HIV virus per se, or the severity of infection as reflected by the CD4 count.

AIDS-Related Opportunistic Infections↗