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Cytomegalovirus (CMV) antibody in male homosexuals: a source for CMV immune globulin.

Male homosexuals have been found to have an extraordinarily high prevalence, and high titers, of antibodies to cytomegalovirus (CMV), as determined by complement-fixation and passive hemagglutination tests. These findings support other data suggesting that CMV may be sexually transmitted. The high titers of CMV antibody found in this population suggest that the homosexual population may be a valuable source of plasma for preparations of CMV immune globulins. CMV immune globulins may be useful in passive immunoprophylaxis or immunotherapy in immunosuppressed patients.

Antibodies, Viral↗

Incidence of HIV infection in a cohort of homosexually active men.

The purpose of this study was to estimate the incidence of human immunodeficiency virus (HIV) in a cohort of homosexually active men in Sydney. In 1984-85 the Sydney AIDS Prospective Study enrolled homosexually active men, who were followed by six-monthly visits, although regular contact with most participants ceased in the early 1990s. In 1993-94 a major effort was made to establish the HIV status of all participants who had attended more than once. Of the 1075 men enrolled, 528 (49 per cent) were negative at enrollment and had at least one further documented HIV test. The annual incidence rate of HIV infection was highest in the early years of the study, 1984 (9.6 per cent) and 1986 (5.0 per cent), and remained low from 1987 (1.9 per cent) to 1994 (0.0 per cent). The incidence of HIV infection was higher among men aged under 34 years at enrollment and men who reported more than four sexual partners in the six months before enrollment, but these associations disappeared by 1987. The decrease in HIV incidence is consistent with findings from other cohorts followed for this length of time.

Adolescent↗

Prevalence and risk factors of hepatitis C in HIV-negative homosexual men in Sydney, Australia.

OBJECTIVE: To determine the prevalence and risk factors for hepatitis C (HCV) in HIV-negative homosexual men in Sydney. METHODS: A cohort study was conducted in a sample of community-based, HIV-negative, homosexual men in Sydney. Participants underwent a face-to-face interview regarding sexual behaviour, sexually transmissible infections, and injecting drug use (IDU). RESULTS: Eight hundred and twenty-four men consented to HCV testing, and the prevalence was 0.85% (95% CI 0.34-1.74). HCV seropositivity was strongly associated with a history of IDU (OR = 60.43, 95% CI 6.70-544.79). All HCV seropositive individuals reported a history of either IDU or other means by which they may have had parenteral exposure to HCV. There was no evidence of an independent association between sexual behaviour and HCV infection. CONCLUSION: The prevalence of HCV in this cohort was about the same as in the general population in Australia, and there was no evidence for sexual transmission in this population.

Adolescent↗

Immunologic and virologic findings in hemophiliacs do not correlate with ecto-5'nucleotidase activity of peripheral blood lymphocytes. A difference with homosexual men.

It has been recently demonstrated that ecto-5'nucleotidase (5'NT) activity is significantly decreased in the peripheral blood lymphocytes (PBL) of homosexual men. This paper reports a study of PBL 5'NT activity in 38 hemophiliacs at risk for the acquired immunodeficiency syndrome (AIDS). The enzyme activity was correlated to the immunologic and virologic data. T-cell subset distribution was unbalanced and directly correlated with the cumulative amount of AHF infused. PBL 5'NT activity, however, was similar to that of healthy controls. 6 patients displayed serum antibodies to the human immunodeficiency virus (HIV) but no decrease in PBL 5'NT activity. In conclusion, these data indicate that both heavily treated and seropositive as well as untreated hemophiliacs have normal PBL 5'NT activity. This striking dissimilarity between homosexual men and hemophiliacs suggests that some immunologic alterations leading to 5'NT deficiency occur in the former only.

5'-Nucleotidase↗

Oral candidiasis in HIV infection: predictive value and comparison of findings in injecting drug users and homosexual men.

The objectives of this study were to compare the relationship of oral candidiasis to HIV status, cohort and CD4+ lymphocyte values in injecting drug users and homosexual men and to examine its impact on prognosis. An oral examination was added to an ongoing longitudinal study of HIV infection. Data obtained at 6-month intervals included smoking, illicit drug use, medication use, symptoms and medical diagnoses, physical examination findings and laboratory data. In this study HIV+ subjects were much more likely to present with oral candidiasis than were HIV- subjects (OR = 6.3, P < 0.01). Injecting drug users, regardless of serostatus, were more likely than homosexual men to present with oral candidiasis (OR = 3.0, P = 0.001). In both cohorts oral candidiasis was associated with low CD4+ lymphocyte counts and percent ages, and Kaplan-Meier survival estimates showed that subjects with oral candidiasis had a poorer prognosis than those without candidiasis, even after controlling for CD4+ lymphocyte count.

AIDS-Related Opportunistic Infections↗

Quantification of CD8-positive lymphocytes in lymph node follicles from HIV-infected male homosexuals and controls.

The number of CD8-positive cells in follicular centres of hyperplastic lymph nodes from 20 Danish and Swedish homosexual men with persistent generalized lymphadenopathy and 43 control patients were enumerated in frozen tissue sections immunostained with monoclonal antibody reactive with the CD8-antigen ("cytotoxic-suppressor" T-cell antigen). All the homosexuals were seropositive for HIV and histology showed changes characteristic of the early stage of HIV lymphadenitis. A significant increase (p much less than 0.001) of CD8-positive cells was demonstrated (mean 1,307 per mm2 follicular centre, SD 639) in HIV-related lymphadenopathy compared with the controls (mean 161 CD8-positive cells per mm2 follicular centre, SD 169). The results of this study show that the immunohistological demonstration of a significant increase of CD8-positive cells in the follicles of hyperplastic lymph nodes is suggestive of HIV-related lymphadenopathy.

Acquired Immunodeficiency Syndrome↗

The phenomena of police fantasies, leg fetish, and father identification in a homosexual male.

TOPIC: The relationship of police fantasies and leg fetish to identification with the father in a homosexual male. PURPOSE: To describe two manifestations of identification with the father in a male homosexual. SOURCE: The author's clinical work. CONCLUSION: It is important to decode current behavior in light of theory and past history, to help clients move from potentially destructive behavior to satisfying interpersonal interactions.

Fantasy↗

Immune derangements in asymptomatic male homosexuals in Israel: a pre-AIDS condition?

We have described several immune derangements found in a clinically asymptomatic group of 117 male homosexuals (MHS) in Israel. These consisted of a marked decrease in TH and TS cells, decreased NK and allogeneic response, and increased levels of acid labile alpha-interferon and circulating immune complexes (CIC). Most of these alterations were found in approximately 40% of the subjects, with no simple correlation between them. Since Israel is a low incidence area for AIDS and related syndromes, it is suggested that this situation reflects a common situation among asymptomatic MHS in general, although the reasons for these impairments are not clear. This situation may therefore explain susceptibility of the male homosexual for developing AIDS, given the appropriate circumstances, environment, and genetic background.

Acquired Immunodeficiency Syndrome↗

Changes in sexual behaviour between 1986 and 1988 in matched samples of homosexually active men.

Matched samples of homosexually active men were obtained using identical sampling methods in a city of one million people in 1986 and 1988. Data indicated that reported sexual behaviours had significantly changed in the direction of safer sex, particularly oral sex without ejaculation, anal sex with a condom (both insertive and receptive), which increased in frequency, and analingual and digitoanal receptive practices, wet kissing, and anal receptive intercourse generally, which decreased. Reported sources of education for both samples were primarily gay media and gay organisations. These data, with some caveats concerning design and comparability of samples, suggest that behavioural change in the appropriate direction has occurred in homosexually active men, and that gay organisations and media have been perceived as the most common source of information on safer sex in this population.

Acquired Immunodeficiency Syndrome↗

A difference in hypothalamic structure between heterosexual and homosexual men.

The anterior hypothalamus of the brain participates in the regulation of male-typical sexual behavior. The volumes of four cell groups in this region [interstitial nuclei of the anterior hypothalamus (INAH) 1, 2, 3, and 4] were measured in postmortem tissue from three subject groups: women, men who were presumed to be heterosexual, and homosexual men. No differences were found between the groups in the volumes of INAH 1, 2, or 4. As has been reported previously, INAH 3 was more than twice as large in the heterosexual men as in the women. It was also, however, more than twice as large in the heterosexual men as in the homosexual men. This finding indicates that INAH is dimorphic with sexual orientation, at least in men, and suggests that sexual orientation has a biological substrate.

Anterior Hypothalamic Nucleus↗

Homosexual rape and sexual selection in acanthocephalan worms.

Acanthocephalan males have cement glands associated with the vas deferens, secretions from which seal the female vagina with a cap after copulation and so prevent subsequent insemination. Homosexual rape results in the male victim having the genital region sealed off with cement and effectively removed from the reproductive population. Sperm and cement are transferred to females during copulation, but apparently only cement is transferred to males during homosexual rape. Acanthocephalans conform to a parental investment model, and we interpret the evolution of the cement gland and sexual behavior as the result of sexual selection.

Acanthocephala↗

Long-term serologic follow-up of hepatitis C virus-seropositive homosexual men.

Hepatitis C virus (HCV) infection may go undiagnosed and continue to present a source of community-acquired or transfusion-associated infection because of shortcomings in sensitivity, specificity, and reproducibility of serologic tests. This project was designed to longitudinally study persons who were HCV seropositive or were at risk for seroconversion to characterize the course of infection. Sequential serum samples obtained semiannually from 617 homosexual male volunteers were available for study from the Pittsburgh site of the Multicenter AIDS Cohort Study. Testing by anti-HCV enzyme immunoassay (EIA) was performed on baseline (1984 to 1985) and most-recent (censor date, August 1992) samples. Selected samples were also assayed for alanine aminotransferase and by recombinant immunoblot (RIBA II) and nested PCR. A total of 17 of 617 (2.8%) men were HCV seropositive at entry. Of the 600 seronegative men, 9 converted to HCV seropositive during the study interval. Parenteral sources of exposure could be identified in 6 of these 26 HCV-seropositive men. Four men were HCV seropositive at baseline and seronegative at their most recent visit. Of the 26 HCV-seropositive men, 12 were also seropositive for human immunodeficiency virus. EIA analysis of 298 longitudinal samples from the 26 men revealed three patterns of HCV seropositivity: persistent, intermittent, and rare. Nine men (35%) showed intermittent or rare seropositivity with periods of over 1 year between some seropositive samples. PCR was positive in 76% of the HCV EIA-positive and 84% of the RIBA-positive samples. Thus, a low but significant number of homosexual men were HCV seropositive with variable positivity over several years of follow-up. A portion of these men become HCV seronegative. Individuals who exhibit intermittent or rare seropositivity are a challenge to diagnosis.

Adult↗

Campylobacter fetus subsp. fetus in homosexual males.

Campylobacter fetus subsp. fetus was isolated from the stools of two homosexual males. One was asymptomatic at the time of isolation. The other presented with diarrhea. Both isolates were initially grown at 42 degrees C. This organism should be included among the list of organisms that are found in homosexual males.

Campylobacter fetus↗

Prevalence of enteric parasites in homosexual patients attending an outpatient clinic.

A total of 372 pooled stool specimens from 274 homosexual men with diarrhea were submitted for parasitologic examination over a 2.5-year period. Each two-vial pooled specimen set contained portions of stool from 3 consecutive days in Formalin and polyvinyl alcohol. Of the 274 patients, 133 (48.5%) harbored one or more intestinal protozoa, with 161 (43.3%) of the 372 specimens submitted being positive for one or more organisms. The parasites identified included Entamoeba histolytica (71 patients), Giardia lamblia (22 patients), Endolimax nana (106 patients), Entamoeba coli (39 patients), Entamoeba hartmanni (25 patients), Dientamoeba fragilis (3 patients), Iodamoeba bütschlii (2 patients), and Chilomastix mesnili (2 patients). Cryptosporidium sp. (2 patients) and Isospora belli (1 patient) were also detected. Results of this study support the experience of other workers regarding high rates of infection with intestinal parasites in the homosexual population and also indicate that symptomatic individuals belonging to this acquired immunodeficiency syndrome risk group be screened for both common and uncommon intestinal pathogens.

Adult↗

Evidence for depressed humoral immunity to Pneumocystis carinii in homosexual males, commercial plasma donors, and patients with acquired immunodeficiency syndrome.

Heterosexual controls were found to have significantly higher titers of immunoglobulin G antibody to Pneumocystis carinii than did patients with the acquired immunodeficiency syndrome (AIDS) and P. carinii pneumonitis, human immunodeficiency virus (HIV) antibody-positive or -negative homosexual male "gay bar" patrons, and HIV antibody-positive or -negative commercial plasma donors. The T-helper/T-suppressor lymphocyte ratios of HIV antibody-negative homosexual male gay bar patrons were slightly depressed (mean = 1.31 +/- 0.54) compared with those of heterosexual controls (mean = 1.79 +/- 0.32). In addition to other recognized factors, preexisting humoral as well as cell-mediated immune deficits before infection with HIV may help to explain the prevalence of and morbidity and mortality associated with P. carinii pneumonitis in AIDS patients.

Acquired Immunodeficiency Syndrome↗

Prospective multicenter study on isolation of human immunodeficiency virus type 1 from homosexual men after seroconversion.

A prospective multicenter study was undertaken to isolate human immunodeficiency virus type 1 (HIV-1) from 45 homosexual men for a period of 30 months after seroconversion. Efficiency of HIV-1 isolation from peripheral blood mononuclear cells was relatively stable over time, ranging from 64% at the time of seroconversion to more than 82% after 18 months of seroconversion. However, Kaplan-Meier analysis of HIV-1 culture data indicates that the cumulative proportion of HIV-1 culture positivity at 3, 6, 12, and 18 months after seroconversion was 62, 65, 84, and 92%, respectively. No significant correlation was observed between the presence of HIV-1 p24 antigen in serum, or numbers of CD4+ and CD8+ blood lymphocytes, and HIV-1 isolation within this period of time. These data suggest that HIV-1 viremia in homosexual men gradually increases to almost 100% culture positivity by 18 months after seroconversion.

HIV Seropositivity↗

Severe acquired immunodeficiency in European homosexual men.

Four previously healthy Danish homosexual men developed Kaposi's sarcoma or opportunistic infections with fever of unknown origin and lymphadenopathy. One patient died of a Pneumocystis carinii pneumonia. Three patients had defective cell-mediated immunity with absent leucocyte interferon production and decreased proliferative response to mitogens and antigens. T lymphocyte helper subsets and natural killer cell activity were reduced. Unstimulated mononuclear cells produced leucocyte migration inhibitor factor. Two patients were sexual partners and three had never been to the USA, where cases of severe acquired immunodeficiency have been reported. Thus, the syndrome must also be suspected in European homosexual men who present with fever of unknown origin, opportunistic infections, or Kaposi's sarcoma.

Adult↗

Should homosexuals be vaccinated against hepatitis B virus? Cost and benefit assessment.

The recent introduction of a vaccine against hepatitis B has raised the questions of who should be offered it and what the cost would be of a vaccination programme. An analysis was performed of the financial costs and benefits of such a programme designed to prevent acute hepatitis B in male homosexuals in the United Kingdom. Under various assumptions the total costs of screening and vaccination ranged from 2.2m pounds to 3m pounds for a five year programme and from 3.3m pounds to 4.8m pounds for a 10 year programme. The benefits over the same two periods for the programme, depending on two different assumptions of mortality prevented, ranged 3.9m pounds to 13.7m pounds and from 7m pounds to 24.4m pounds. Thus considerable savings may be made to the national economy by offering vaccination to homosexuals. These savings are obtained after consideration of only the acute aspects of hepatitis B. Had it been possible to determine the costs of the chronic sequelae of this disease the savings, compared with the costs, would have been greatly increased.

Absenteeism↗