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Extensive T8-positive lymphocytic visceral infiltration in a homosexual man.

Lymphocytic visceral infiltration has recently been noted in association with lymphadenopathy-associated virus infection. A homosexual man, who had clinical and immunologic features of the acquired immune deficiency syndrome (AIDS)-related complex, is described. The patient presented not only with peripheral blood lymphocytosis but also with extensive lymphocytic infiltration involving lungs, lymph nodes, nerves, muscles, and esophagus. Lymphocyte subset immunostaining analysis showed that the lymphocytes were T8-positive. Thirty months after the clinical onset of the disease, no evidence of progression to AIDS was seen. Moreover, clinical improvement was observed, even though the patient did not receive long-term treatment. The clinical history of this patient suggests that lung T8-positive lymphocytic infiltration is associated with an increased risk of infectious episodes such as pneumonia and bronchitis.

AIDS-Related Complex↗

Malignant melanoma in a homosexual man with HTLV-III/LAV exposure.

An HTLV-III/LAV antibody-positive homosexual man in whom disseminated malignant melanoma developed is described. Immunologic analysis revealed an increase in suppressor/cytotoxic phenotype (Leu-2-positive) T cells, depressed proliferative response to mitogens, decreased proportions of T cells with interleukin-2 receptors but normal production of both interleukin-2 and interleukin-1, cutaneous anergy, elevated levels of serum IgG and IgA, and presence of autoantibodies against smooth muscle and parietal cells of the stomach. This case stresses the need for reporting all types of neoplasms associated with exposure to HTLV-III/LAV so that their true incidence in the population "at risk" for the acquired immune deficiency syndrome can be determined.

Adult↗

Hemophilus parainfluenzae prostatitis in a homosexual man with chronic lymphadenopathy syndrome and HTLV-III infection.

Hemophilus parainfluenzae, a common upper respiratory tract pathogen, has been reported to cause pharyngitis, epiglottitis, otitis media, conjunctivitis, and pneumonia. Rarely H. parainfluenzae infects the urinary tract, and is believed not to have been previously reported as a cause of prostatitis. A case of H. parainfluenzae in a young homosexual man infected with HTLV-III and chronic lymphadenopathy is described. Common clinical syndromes such as prostatitis may be associated with unusual pathogens in persons immunodeficient due to HTLV-III infection.

AIDS-Related Complex↗

Correlation of enzyme-linked immunosorbent assays for serum human immunodeficiency virus antigen and antibodies to recombinant viral proteins with subsequent clinical outcomes in a cohort of asymptomatic homosexual men.

A cohort of asymptomatic homosexual men at a Boston community health center was screened for the presence of human immunodeficiency virus (HIV) serum antigen and antibodies to recombinant proteins containing portions of the envelope and the gag (core) gene products. Of 196 asymptomatic men screened, 149 were antigen-negative/antibody-negative, 41 were antigen-negative/antibody-positive, and six were antigen-positive/antibody-positive. All three men in whom the acquired immune deficiency syndrome (AIDS) developed over the next year were antigen-positive at enrollment. Although a larger portion of the men who were antigen-positive and did not demonstrate progression to AIDS after one year had thrush, zoster, or generalized lymphadenopathy, the associations were not statistically significant. Whereas all of the seropositive men had antibody to viral envelope antigens, about a quarter did not have detectable antibodies to recombinant core antigens. However, all of these men had detectable antibody to core antigens by Western blot. Titers to recombinant core and envelope antigens tended to be lower in the men with AIDS. HIV-infected persons who are more likely to have enhanced immuno-compromise may be identified by these newer tests, but further longitudinal studies will be necessary to fully understand their prognostic value.

AIDS-Related Complex↗

Prevalence of enteric pathogens in homosexual men with and without acquired immunodeficiency syndrome.

We studied 388 homosexual or bisexual men from the Baltimore-Washington area to define the spectrum of enteric pathogen carriage in a population at high risk for "gay bowel syndrome" in association with human immunodeficiency virus infection. Seventy-seven patients with acquired immunodeficiency syndrome, 68 gay men with symptoms of acute diarrhea or proctitis, and 243 gay men without gastrointestinal symptoms and participating in a natural history study of human immunodeficiency virus infection were selected for study. Approximately 12% of the asymptomatic men harbored at least one enteric pathogen; the most frequently recovered were Chlamydia trachomatis, herpes simplex virus, and Giardia lamblia. Men carrying a pathogen were more likely to be human immunodeficiency virus seropositive (48%) than men without a pathogen (25%) (p = 0.018), more likely to have fewer T helper cells (p = 0.015), and more likely to have a mucopurulent exudate (p = 0.014). We recovered an agent of enteric disease from 68% of gay men presenting with diarrhea or proctitis. Campylobacter species, herpes simplex virus, Neisseria gonorrhoeae, C. trachomatis, G. lamblia, and Shigella species were identified most frequently. The most common pathogen associated with diarrhea in acquired immunodeficiency syndrome was Cryptosporidium (16% of 49 cases). Other agents identified were Clostridium difficile, Vibrio parahemolyticus, Campylobacter species, G. lamblia, Isospora, and cytomegalovirus. Approximately half of the identifiable etiologic agents of diarrhea in acquired immunodeficiency syndrome patients were treatable with antibiotics, but these agents required special culture procedures for detection.

Acquired Immunodeficiency Syndrome↗

Active coping style is associated with natural killer cell cytotoxicity in asymptomatic HIV-1 seropositive homosexual men.

The aim of this study was to examine the hypothesis that a psychosocial model was associated with natural killer cell cytotoxicity (NKCC) in HIV-1 infection. A sample of 62 HIV-1 seropositive homosexual men at CDC stages II and III were given a psychosocial battery assessing life stressors, social support, and coping style. A regression model quantifying these variables along with control variables for alcohol use, substance use and nutritional status was estimated. Active coping style was directly and positively associated with NKCC, and trends toward a negative relationship of life stressors and a buffering effect of social support on lives stressors were also observed. The results suggest that (1) control variables should be included with psychosocial models and that (2) psychosocial factors, especially active coping, may have a deterrent effect on loss of NK cell function. Active coping style may merit a specific focus in future research of life stressors and the immune system.

Adaptation, Psychological↗

Active confrontational coping predicts decreased clinical progression over a one-year period in HIV-infected homosexual men.

The association between stressful life events, psychiatric symptoms, coping, and social support and HIV disease progression one year later were studied in 51 HIV-infected asymptomatic and early symptomatic homosexual men. Dependent variables were CD4 counts and clinical progression. No associations between the psychosocial parameters and CD4 counts were found. Active confrontation with HIV infection as a coping strategy was predictive of decreased clinical progression at one year follow-up, after taking into account baseline biomedical and behavioral variables. These results show that active coping strategies may have an effect on disease progression, possibly mediated by greater compliance with medical treatments or by psychoneuroimmunological mechanisms.

Adaptation, Psychological↗

A stochastic model of the HIV epidemic and the HIV infection distribution in a homosexual population.

In this paper we develop a stochastic model for the HIV epidemic in a homosexual population and use the model to characterize the HIV infection distribution and seroconversion distribution. Through computer-generated infection distributions and seroconversion distributions, we assess the effects of various risk factors on these distributions. The fitting of some data sets generated by computer suggests that the three-parameter generalized log-logistic distribution should be assumed as the infection distribution for the proposed stochastic model of HIV epidemics.

Disease Outbreaks↗

Comments on Lindesay: laterality shift in homosexual men.

The raised incidences of strong left-handedness and of mixed-handedness in homosexual men, as in dyslexics, are mutually consistent under the normal distribution function, as expected by the right shift theory of handedness. It is argued that atypical laterality in these groups is better described as a "reduction of right shift" than as a "left shift".

Differential Threshold↗

Oral manifestations of tumor and opportunistic infections in the acquired immunodeficiency syndrome (AIDS): findings in 53 homosexual men with Kaposi's sarcoma.

Fifty-three homosexual men with Kaposi's sarcoma (KS) were studied. Twenty-seven had biopsy-proved oral KS, the palate being the most common site. Past or present infections with cytomegalovirus, hepatitis, venereal diseases, and gastrointestinal microorganisms occurred in more than 70%. Oral candidiasis was confirmed in 57%. Heavy marijuana smoking was the most common habit. Transmission of AIDS is thought to be by a viral agent. Precautions involving the use of gloves, eyeglasses, and masks, similar to those recommended for the management of patients with hepatitis B, are urged.

Acquired Immunodeficiency Syndrome↗

Oral condyloma planus (hairy leukoplakia) among homosexual men: a clinicopathologic study of thirty-six cases.

Thirty-six cases of oral condyloma planus (hairy leukoplakia) occurring in homosexual men are reported. The average age is 36.6 years, with a range from 24 to 51 years, and the disorder exhibits a predilection for the fourth decade. More than 86% of the cases are localized to the tongue (72% lateral border, 14% ventral surface). Microscopically, surface candidiasis could be detected with periodic acid-Schiff staining in 88% of the instances. Parakeratosis with koilocytotic atypia was the characteristic histologic finding; however, comparison with twenty-five cases of leukoplakias exhibiting parakeratosis and twenty-five cases of candidiasis among heterosexual individuals disclosed that koilocytotic changes are not specific for condyloma planus. Follow-up data were obtained in thirty-two cases with a mean of 11 months. During this period six patients died or were hospitalized with a diagnosis of acquired immunodeficiency syndrome.

Adult↗

Oral Kaposi's sarcoma: a clinicopathologic study of 23 homosexual and bisexual men from the New York metropolitan area.

A total of 3970 cases of Kaposi's sarcoma (KS) associated with the acquired immunodeficiency syndrome had been reported to the Centers for Disease Control by the end of 1986. The prevalence of oral KS in patients with KS of the skin varies, reaching a maximum of 44% in one published study. We present a retrospective clinicopathologic analysis of 23 previously unreported cases of oral KS in male homosexual and bisexual patients from the New York metropolitan area. Our data reveal that 21 of the patients had KS confined to the oral cavity and that, in 16 cases, the oral KS was the first presenting sign of the acquired immunodeficiency syndrome. Sixteen of the 23 patients had solitary oral lesions. Nineteen of the tumors showed prominent endothelium-lined capillaries resembling lymphatics, 16 exhibited a prominent spindle cell component, and 17 demonstrated areas of fibrosis. Of the 13 patients for whom there was adequate follow-up information, five were dead within 6 to 15 months. All five deaths were due to Pneumocystis pneumonia.

Acquired Immunodeficiency Syndrome↗

Human immunodeficiency virus isolates from asymptomatic homosexual men and from AIDS patients have distinct biologic and genetic properties.

Human immunodeficiency virus type 1 (HIV-1) isolates from asymptomatic homosexual men and AIDS patients were compared for their in vitro biologic and genetic properties. Most of the HIV-1 isolates from asymptomatic men, but not from AIDS patients, failed to infect CD4+ H9 cells and phytohemagglutinin-stimulated peripheral blood lymphocytes. In a longitudinal study, serial HIV-1 isolates obtained from men who seroconverted to HIV-1 and later developed AIDS were able to infect H9 cells. In contrast, longitudinal isolates from men who remained asymptomatic did not infect H9 cells. HIV-1 isolates from AIDS patients in general exhibited increased production of intracellular viral DNA, RNA, and protein as compared to isolates from asymptomatic men. Cells infected with HIV-1 isolates from asymptomatic men produced very little gp120, p24, and p55 proteins as compared to those from AIDS patients. The overall restriction patterns of HindIII, Sac-1, Pst-1, EcoR1, and BamH1 were very similar between HIV-1 isolates from asymptomatic men and those from AIDS patients. However, the restriction endonuclease pattern of BglII was quite distinct for isolates from asymptomatic men as compared to AIDS patients. Preliminary studies mapped a unique BglII site in the gag region of most of the isolates from asymptomatic men, approximately 2.0 kb from the 5' end. Thus, HIV-1 isolates from asymptomatic subjects and from AIDS patients have distinct biologic and genetic properties which may be related to the various clinical outcomes of HIV-1 infection.

Acquired Immunodeficiency Syndrome↗

Acquired immunodeficiency syndrome-like illness associated with systemic Mycoplasma fermentans infection in a human immunodeficiency virus-negative homosexual man.

A 35-year-old homosexual man developed a composite nodal Kaposi's sarcoma and peripheral T-cell lymphoma that were associated with a peripheral blood CD4-positive lymphocyte count of only 43/mm3. The patient subsequently developed Pneumocystis carinii pneumonitis and eventually died due to disseminated Cryptococcus neoformans. Numerous premortem tests for the presence of human immunodeficiency virus (HIV) types 1 and 2 were negative by the enzyme-linked immunosorbent assay, Western blot, viral isolation, and polymerase chain reaction techniques. Postmortem evaluations for HIV-1, HIV-2, human T-cell lymphotropic virus (HTLV)-I, and HTLV-II also were negative by polymerase chain reaction, immunofluorescence assays, and viral isolation. A systemic infection by Mycoplasma fermentans, however, was documented by immunohistochemistry and polymerase chain reaction in premortem and postmortem tissues. This recently recognized human pathogen has produced systemic infections in patients with the acquired immunodeficiency syndrome (AIDS) and in previously healthy non-AIDS patients who characteristically have a fulminant flu-like illness. Additionally, M fermentans has enhanced the cytopathic effect of HIV in in vitro studies and has produced fatal wasting illnesses with terminal lymphopenia in inoculated adult silvered leaf monkeys. This report is the first description of an association between M fermentans infection and an AIDS-like illness in an HIV-negative individual. The etiology of the severe immunosuppression in this patient and the associated role of M fermentans remain to be determined by further investigations.

Acquired Immunodeficiency Syndrome↗

Decreased 5'-nucleotidase activity in suppressor (OKT8) T lymphocytes from homosexuals with AIDS-related complex: nonassociation with enhanced deoxynucleoside toxicity.

The purine metabolic enzymes adenosine deaminase (ADA), purine nucleoside phosphorylase (PNP), and 5'nucleotidase (5NT) have been shown to be important for normal lymphocyte maturation. Abnormalities of these enzymes have been associated with hereditary as well as acquired immunodeficiency states. Enzyme activity was measured in helper (OKT4) and suppressor (OKT8) lymphocyte subsets from 10 homosexuals with AIDS-related complex (ARC) and in 10 healthy controls. There were no significant differences in either mean ADA activity or mean PNP activity between ARC OKT4 cells and control OKT4 cells and between ARC OKT8 cells and control OKT8 cells. By contrast, mean 5NT activity was slightly decreased in OKT4 cells from ARC patients compared with that of controls and more significantly diminished in ARC OKT8 cells compared with that of controls. Both deoxyadenosine and deoxyguanosine, when incubated separately with OKT4 and OKT8 cells in the presence of EHNA, an ADA inhibitor, did not significantly inhibit lymphocyte blastogenesis to a greater extent in ARC patients than in controls. Hence, the decreases in 5NT activity most likely reflect lymphocyte immaturity and are not associated with biochemical abnormalities leading to increased deoxynucleoside toxicity.

5'-Nucleotidase↗

T-cell subset alterations in HIV-infected homosexual men: NIAID Multicenter AIDS cohort study.

Immunologic changes in HIV-infected homosexual men without AIDS were studied using flow cytometry and monoclonal antibodies. A decline in CD4 cells occurred after anti-HIV antibodies detectable by ELISA developed. CD4 T-cell levels dropped to an average of 60% of their original level within 12-18 months after seroconversion. Subsequently, CD4 levels remained constant in most HIV seropositive men for several years. However, in men who developed AIDS, there was a rapid fall in the CD4 level during the 2 years prior to development of AIDS. Throughout the course of HIV disease, the total T-cell levels (CD3) remained constant, apparently due to CD8 lymphocytosis. The selective depletion by HIV infection of discrete functional subsets of CD4 cells was examined using 4B4, 2H4, HB-11, and Leu-8 monoclonal antibodies and dual color immunofluorescence. No selective depletion of CD4 subsets was noted using any of these reagents. However, selective activation of subsets of CD8 lymphocytes characterized disease progression. In particular, increases in the number of HLA-DR+, CD38+ (OKT10), and Leu-8- CD8 lymphocytes were associated with a fall in CD4 levels and development of AIDS.

Acquired Immunodeficiency Syndrome↗

Lymphocyte subset analysis to predict progression to AIDS in a cohort of homosexual men in San Francisco.

A group of 10 leukocyte and lymphocyte subsets were measured by simultaneous dual immunofluorescence and flow cytometry in a group of homosexual men from the San Francisco General cohort. Absolute numbers and percentages of lymphocytes were determined in 30 individuals who progressed to AIDS and 29 who did not over a 44-month period at annual intervals. At entry into the study, all subjects were asymptomatic, HIV seropositive, and had multiple changes in lymphocyte subsets compared to HIV-negative controls. In progressors, large changes occurred from the first visit to the last visit before progression in both absolute numbers and percentages of CD4 cells. The percentage of HLA-DR-bearing CD8 cells also increased. We utilized a proportional hazards model to assign a predictive value for progression to AIDS to lymphocyte subsets in both univariate and multivariate tests. Increased DR-positive CD8 cells, decreased CD4 cells, and increased CD8-positive, Leu 7-positive cells independently predicted progression to AIDS at P less than 0.006 (relative hazard 5.8-4.0). In a multivariate model, the most useful tests were either increased numbers or percentages of DR-positive CD8 cells. These data suggest parsimonious approaches to following HIV-positive individuals and further support the possibility of autoreactive T cells in the pathogenesis of HIV-associated diseases.

Acquired Immunodeficiency Syndrome↗

Acute urinary retention in young homosexuals.

Acute urinary retention secondary to and intercourse was found in 4 homosexuals. All four were treated initially with an indwelling Foley catheter and then with bethanechol and phenoxybenzamine (Dibenzyline). Normal micturition was restored in all 4 patients. Anal dilatation can produce reflex bladder inhibition resulting in acute retention.

Acute Disease↗