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We report five patients who illustrate the usefulness of fine-needle aspiration cytology (FNAC) in the differential diagnosis of lymphadenopathy in homosexual males. This differential includes hyperplasia, disseminated Kaposi's sarcoma, mycobacterial infections, and non-Hodgkin's lymphoma.
The early effects of infection with human immunodeficiency virus (HIV) were investigated in homosexual men who had seroconverted for anti-HIV antibodies. Leukocyte functional activities were determined in longitudinally collected peripheral blood mononuclear cell samples. During the first 10 months following seroconversion, anti-CD3 monoclonal antibody-induced T cell proliferation, monocyte accessory function and T helper activity on B cell differentiation in a pokeweed mitogen-driven system were not affected. In contrast, from the moment of seroconversion on, B cells of seroconverted men failed to produce immunoglobulin in the pokeweed mitogen-driven system. This defect was not restored by addition of normal CD4+ T cells. Immunoglobulin synthesis induced by Staphylococcus aureus and interleukin 2 decreased gradually, until it was completely lost 10 months after seroconversion. In addition, proliferation in response to anti-IgM or Staphylococcus aureus by B cells from HIV seroconverted men was decreased. The lack of inducible in vitro B cell activity was not accompanied by elevated spontaneous Ig synthesis by B cells of the seroconverted men. In the second group of men studied during the 2nd year following seroconversion, T helper activity on normal B cell differentiation significantly decreased, whereas anti-CD3-induced T cell proliferation and monocyte accessory function were not significantly affected. Our results demonstrate that in almost all HIV-infected individuals B cell functional defects are the first leukocyte abnormalities observed preceding defects in T helper activity.
The presence of antibodies to HTLV-III and markers of active hepatitis B virus replication was examined in a longitudinal study of 33 consecutive male homosexual HBsAg carriers. The mean follow-up time was 37 months (range = 4 to 109 months). All patients were initially hepatitis B virus DNA-positive and HBeAg positive. Antibodies to HTLV-III were detectable in eight patients while they were positive for both of these markers. One of them cleared hepatitis B virus DNA and seroconverted from HBeAg to anti-HBe. This corresponds to an annual clearance/seroconversion rate of 4% (95% confidence limits = 0 to 15%). In two patients, antibodies to HTLV-III appeared after clearance of hepatitis B virus DNA and HBeAg, and in one of them, hepatitis B virus DNA reappeared. Among the 25 patients negative for HTLV-III antibodies, the annual hepatitis B virus DNA clearance rate was 20% and HBeAg to anti-HBe seroconversion rate was 11% (95% confidence limits = 11 to 31% and 4 to 20% respectively). The observed hepatitis B virus DNA clearance rates in the two groups were significantly different (p less than 0.05). Disease activity, as determined by transaminase levels, was significantly lower in HTLV-III-infected individuals as compared to individuals without HTLV-III infection (p less than 0.05). Infection with HTLV-III may extend the period of active viral replication or even reactivate hepatitis B virus replication and seems to diminish inflammatory disease activity in chronic HBsAg carriers.
During the 7th annual follow-up of our cohort of homosexual men in 1989, we tested the hypotheses that infection with human immunodeficiency virus (HIV) may enhance the expression of human papilloma virus (HPV) and that the development of anal epithelial abnormality is related to a biologic interaction between these two viruses. Overall, 41 (39%) of the 105 men had anal swabs positive for one or more genotypes of HPV 6/11, 16/18 or 31/33/35. Twenty-three (53%) of the 43 HIV-positive subjects harbored HPV compared to 18 (29%) of the 64 HIV-negative subjects (p = 0.012), including higher prevalence rates for HPV genotypes 16/18 (p = 0.01), 6/11 (p = 0.007), and 31/33/35 (p = 0.07). Multivariate logistic regression analysis of the HIV-positive subjects showed low CD4+ cell counts to be an independent risk factor for detection of HPV (p = 0.04) and in particular for HPV genotypes 31/33/35 (p = 0.02) and 6/11 (p = 0.07). In contrast, similar analysis of the HIV-negative subset showed that a positive antibody test for syphilis was associated with HPV (p = 0.03). Anal epithelial abnormalities were found in 13 (14%) of 92 technically adequate cytologic smears and were strongly associated with detection of any HPV genotypes by the dot-blot method (p = 0.01), and in particular with HPV genotypes 6/11 (p = 0.001). None of 15 subjects with HPV detected only by PCR had anal epithelial abnormality. We propose a viral interaction model, in which HIV-related immune deficiency allows reactivation of HPV, with a subsequent or concomitant appearance of epithelial abnormality.
Thirty-five homosexual men who had been the regular sexual partners (for at least 6 months) of anti-HIV-positive patients with AIDS (N = 18) or PGL (N = 17) were studied. Twenty-one (60%) were seropositive, but 14 (40%) were consistently anti-HIV-negative. The duration of relationship with the index case was not statistically different in seropositive compared to seronegative partners; median 26 months (range 7-60) vs 30 months (range 7-60). However, seropositive partners had a significantly higher monthly number of other sexual partners and sexually transmitted diseases and a higher frequency of insertive and receptive anal intercourse in the preceding five years. The risk of acquiring HIV infection was significantly increased by frequent receptive anal intercourse when the frequency of insertive was controlled for but not the converse. Seronegative partners had undetectable antibodies by live and fixed cell immunofluorescence and by radioimmunoprecipitation and were repeatedly negative by competitive enzyme immunoassay. Furthermore, the sera of seronegative partners lacked HIV neutralising activity. Peripheral blood mononuclear cells (PBMCs) from seronegative partners, stained with monoclonal antibodies to seven different CD4 epitopes, revealed no differences when compared to those from heterosexual controls and no qualitative differences from cells from seropositive individuals. In addition, PBMCs from seronegative partners could be productively infected by HIV in vitro. If resistance to infection in seronegative partners exists, then it is likely that mechanisms other than a specific humoral immunity or CD4 polymorphisms are involved.
Human immunodeficiency virus (HIV) is the primary etiological agent of acquired immunodeficiency syndrome (AIDS). This virus can be transmitted by blood or blood products. Homosexual males (HM) are regarded as one of the high-risk groups for AIDS. Lymphocytes obtained from HM were used for cocultivation with fresh HIV antibody negative lymphocytes. The presence of virus particles was monitored by reverse transcriptase (RT) activity. Three out of eleven donors were found to have reverse transcriptase activity. All three donors were also found to be HIV antibody positive. HIV DNA from infected cells was detected by dot blot hybridization. The number of genome per cell is low. The correlation between RT activity and the cytolytic effect of HIV will be discussed.
To elucidate neurobiological factors related to gender and sexual orientation, event-related brain potentials of 20 heterosexual (HT) men, 20 HT women, 20 homosexual (HM) men, and 20 HM women were examined for neurophysiological differences. Cognitive tasks which typically elicit sex differences were administered. A mental rotation (MR) task assessed spatial ability, and a divided-visual-field lexical-decision/semantic monitoring task (LD/SM) assessed verbal ability and relative degrees of language lateralization. Slow wave activity recorded during MR was greater for HT men than for HT women and gay men. N400 asymmetries recorded during the LD/SM task revealed differences between men and women, but no intrasex differences.
The age-structure of a population, and the distribution of sexual behavior according to age, are significant factors determining the spread of the AIDS epidemic. The threshold conditions for age-structured models account for life-history information, and thus differ significantly from their age-independent counterparts. We examine the threshold conditions for four general age-structured models of the spread of HIV in a homosexual population: three with random partner selection and one with biased partner selection. We consider both discrete and continuous risk groups, and the duration of infection. Susceptibility and infectiousness are treated separately, and the infectivity varies with duration of infection. Through specific examples, we examine the sensitivity of the threshold conditions to the population age-structure and the shape of the infectivity profile. The effects of each are of the same order of magnitude.
In men, sexual orientation correlates with the number of older brothers, each additional older brother increasing the odds of homosexuality by approximately 33%. It is hypothesized that this fraternal birth order effect reflects the progressive immunization of some mothers to Y-linked minor histocompatibility antigens (H-Y antigen) by each succeeding male fetus, and the concomitantly increasing effects of H-Y antibodies on the sexual differentiation of the brain in each succeeding male fetus. This hypothesis is consistent with a variety of evidence, including the apparent irrelevance of older sisters to the sexual orientation of later-born males, the probable involvement of H-Y antigen in the development of sex-typical traits, and the detrimental effects of immunization of female mice to H-Y antigen on the reproductive performance of subsequent male offspring.
Homosexual patients who mainly had the prodrome of the syndrome of opportunistic infection and Kaposi's sarcoma were studied immunologically. Patients showed diminished delayed hypersensitivity to recall antigens, diminished lymphocyte blastogenic responses, a suppressor cell for lymphocyte proliferative responses, low helper cells and an inverted helper:suppressor ratio. The patients had low levels of adherent monocytes. NK cell activity and antibody dependent cellular cytotoxicity were normal. Virtually all patients showed elevated serum thymosin alpha 1 levels and elevated serum lysozyme levels. The most consistent findings were the low helper cells, inverted helper:suppressor ratio and elevated serum thymosin alpha 1 and lysozyme. The patients with the prodrome should be subjected to therapeutic research with immunorestorative drugs.
To identify risk factors for A.I.D.S. among homosexual men in France, a high-risk group in a moderate-incidence area, we undertook a case-control study in Paris and its suburbs. Fifty-three cases were compared to 99 controls from a venereal disease clinic and 79 controls from the staff of an amateur gay broadcasting station. In our univariate analysis, cases were more likely than controls to belong to upper socio-economical classes, to have used local corticosteroids, to have regularly inhaled nitrites, to report history of syphilis and of herpes infections, to have higher level of promiscuity with occasional partners ("one night stands"), and to have had sexual encounters in the U.S.A. In the multivariate analysis, history of syphilis and promiscuity with occasional partners appeared to be the main risk factors, as well as the use of local corticosteroids, especially during the prodrome period. The correlation between promiscuity and disease risk was weak in our study when we did not discriminate between occasional and regular sex partners, contrary to that found in epidemiological studies of A.I.D.S. and H.I.V.-seropositivity in high-incidence areas. In association with the history of syphilis, the development of the syndrome in our moderate-incidence country is more correlated to the contact with "one-night-stand" partners rather than to the total number of the sex partners. The public health policies in our area should be adapted to these findings. Otherwise they may be less efficient than hoped.
Changes in immunologic parameters were followed in members of a cohort of human immunodeficiency virus (HIV)-positive homosexual or bisexual men with lymphadenopathy and were analyzed for differences between those who have and those who have not progressed to the acquired immunodeficiency syndrome (AIDS) (progressors, nonprogressors). T helpers and the Th/Ts ratio were lower in progressors than in nonprogressors both at entry into the study and at the latest visit. T suppressors were not different in the two groups at entry but were higher in nonprogressors at the latest visit. Evaluation of the patterns of change over time showed that T helpers and Th/Ts ratios tended to decrease over time in both nonprogressors and progressors, while T suppressors increased in nonprogressors and decreased in progressors. Although progressors had a greater deterioration in immunologic parameters over time, nonprogressors also had significant deterioration when compared with controls. Based on the respective percentages of men with abnormal or normal T helpers or Th/Ts ratio at entry who have already progressed to AIDS, we would conservatively estimate, considering their latest T helpers and Th/Ts ratio, that at least an additional 16 (32%) of our nonprogressors will develop AIDS in the next 5 years.
Males complaining of erectile and ejaculatory dysfunctions were treated in a structured therapy program. Twenty-one males of heterosexual, homosexual, or bisexual orientation were divided into five groups, with two male therapists for each group. Patients were those usually considered difficult to treat in that 16 had a primary sexual dysfunction with an average duration of 6 years. Extensive evaluations were made before therapy, at the completion of therapy, and at 2-months follow-up. Pre-therapeutic, post-therapeutic, and follow-up measurements indicated that the program was highly successful.
262 respondents from an organization for homosexual foot fetishists provide information from a broader sample than clinical cases and allow examination of the effects of sexual preference on fetishism. Data show a wide range of feet/footwear objects to be arousing. Such interests were often associated with particular types of men, yet interests were subject to change over time. Fetishistic arousal rested on both sensual and symbolic aspects of the fetish. Symbolically, it was the theme of "masculinity" that made male feet/footwear arousing, showing parallels to "femininity" evoked by female feet/footwear for male heterosexual fetishists. For many of the respondents, fetishism did not seem to be a substitute for living persons. Respondents had intimate relationships and were able to incorporate their fetish interests into stable relationships and less intimate ones. Considerable involvement in sadomasochistic practices was also found as was involvement in the gay world. Finally, nothing about a fetishistic interest seemed to preclude the development of subcultural forms around the practice.
The study uses empirical data to generate a preliminary theoretical analysis of the types of interaction and relationships that exist between male homosexuals on the one hand and lesbians and female heterosexuals on the other. Both males' and females' accounts of why they associate with one another in the male gay community are also examined. Methods appropriate to the description of interaction and the collection of accounts of behavior were used: participant observation and interviewing.
Whitam's hypothesis that a majority of gay men exhibit a cross-gender role preference during childhood but that most defeminize by adulthood was tested and supported by data on 1556 gay men. Gay and heterosexual males were found to differ strongly in cross-gender characteristics during childhood but considerably less so during adulthood. By categorizing gay respondents simultaneously by both childhood and adult cross-gendering, sizable differences were found in measures of psychological well-being. No or minimal differences were found between homosexual and heterosexual males on these measures. It was suggested that these two groups may differ not at all or minimally on purely psychological measures but that major differences may be found in cultural variables and particularly in gender culture.
Voluntary control of erectile responses represents a major threat to the validity of penile plethysmography. This study was designed to determine whether individuals can mimic a sexual orientation that differs from their actual sexual orientation. Since the presumed mechanism underlying voluntary control of penile tumescence involves a shift in attentional focus, a recall test was employed to assess the relationship between the ability to influence erectile responses and recall of critical test stimuli. Homosexual and heterosexual subjects were exposed to sexual materials under standard and "faking" instructions. The faking instructions consisted of asking subjects to suppress erectile responses to preferred stimuli and to enhance penile tumescence in the presence of nonpreferred stimuli. Across groups, results revealed some degree of suppression of erections but no significant enhancement of erections. Self-reported cognitive arousal under both conditions was consistent with erectile data. However, subjects' perceived control over erectile responses tended to be greater than their actual performance. No significant differences in recall were obtained. The recall procedure appears to interfere with subjects' ability to control erectile responses. Implications for clinical applications of penile plethysmography are summarized with suggestions for future research.
The parenteral backgrounds of British homosexual and heterosexual women were evaluated on the same questionnaires used with two similar United States samples. The level of adjustment of the subjects was not related to the parental background differences for the British groups. The consistent United States and British findings dealt with how the subjects perceived their parents rather than with how their parents acted toward them.