Comparison of assays to detect cytomegalovirus shedding in the semen of HIV-infected men

We sought to determine the optimal assays for cytomegalovirus (CMV) shedding in semen. Over a 2-month period, 149 HIV-1-infected men who have sex with men each provided up to three semen specimens. Specimens were tested for CMV by culture, rapid assay (shell vial) and polymerase chain reaction (PCR). By culture, 30% of seminal plasma and 28% of seminal cell specimens grew CMV. By rapid assay, results were 38 and 33%, respectively. By PCR, 56% of seminal cell specimens demonstrated CMV: 20% in a single semen specimen; 33% in two specimens; and 34% in all three specimens. Overall, 69% of men had CMV detected by PCR in at least one seminal cell specimen. By quantitative PCR, 14% had ten, 14% had 100, 16% had 1000, and 12% had 10 000 copies in 6.25 μl of semen analyzed. Adjusting for initial CD4+ cell count, men with CMV shedding demonstrated by PCR at the first visit were approximately four times as likely to shed CMV at a subsequent visit (RR 4.28, CI: 2.30–7.95). CMV shedding was associated with decreased CD4+ cell counts in peripheral blood (P=0.05). It is concluded that the PCR assay provided the greatest sensitivity among the three detection methods.     

An application of a mathematical model to adjust for time lag in case reporting

In a dynamic, fluctuating surveillance system, the time lag of case reporting often causes an artificial plateau in an epidemic curve. Arbitrarily ignoring data reported in the most recent period to avoid this bias causes the loss of valuable information. In this report, we propose an application of a mathematical model to adjust for the underreporting bias owing to the time lag of the reporting process. We present an example using the acquired immunodeficiency syndrome incidence data for the homosexual group in the San Francisco surveillance system to illustrate and evaluate prospectively this proposed technique. The results show that the adjusted incidence obtained with the model agrees reasonably well with the true incidence, except for the last month of the period under consideration.     

四川省绵阳市男男性行为人群婚后同性性行为现状及其相关因素分析

目的 了解绵阳市MSM婚后同性性行为现状及其相关因素。方法 2017年1-10月在绵阳市采用滚雪球法招募MSM开展横断面调查,并进行HIV检测,采用多因素logistic回归分析婚后同性性行为的相关因素。采用EpiData 3.1软件和SPSS 19.0软件进行统计学分析。结果 研究对象MSM 234人,婚后同性性行为发生率为94.9%（222/234）,最近6个月有同性肛交占94.4%（221/234）,最近6个月每次肛交安全套使用率为57.9%（128/221）。HIV感染率为8.1%（18/222）。婚后同性性行为发生主要原因为内心驱使（87.8%,195/222）和压力释放（12.2%,27/222）。性伴主要为临时男性性伴（62.2%,138/222）、固定男性性伴（26.1%,58/222）和固定男朋友（11.7%,26/222）。多因素logistic回归分析结果显示,受内心驱使/压力释放而发生婚后同性性行为的相关因素包括文化程度为高中及以上（与初中及以下相比,OR=3.65,95% CI：1.33~9.98）、本地居住时间>1年（与本地居住≤ 1年相比,OR=23.28,95% CI：1.67~324.89）、社区朋友数≥ 10人（与社区朋友数<10人相比,OR=4.15,95% CI：1.28~13.43）、夫妻性生活无快感者（与夫妻性生活有快感者相比,OR=3.25,95% CI：1.22~8.62）、最近6个月肛交人数≥ 2人（与肛交人数≤ 1人相比,OR=0.28,95% CI：0.09~0.81）。结论 绵阳市MSM婚后同性性行为发生率和HIV感染率均较高,由于内心驱使而发生婚后同性性行为的相关因素包括高中及以上文化程度、本地居住时间>1年、社区朋友数≥ 10人、夫妻性生活无快感;由于压力释放而发生婚后同性性行为的相关因素为最近6个月肛交人数≥ 2人。     

Infrared Coagulator™: A Useful Tool for Treating Anal Squamous Intraepithelial Lesions

PURPOSE The incidence of invasive anal squamous carcinoma in men who have sex with men is rising, particularly in those with human immunodeficiency virus. As in the cervix the high-grade squamous intraepithelial lesion is thought to be an invasive squamous cell carcinoma precursor. Cervical high-grade squamous intraepithelial lesions are treated by removing the squamocolumnar transition zone. This is not possible in the anus, where treatment is often surgical and is accompanied by significant pain and morbidity. Better office-based techniques to treat anal high-grade squamous intraepithelial lesions are needed. We employed the infrared coagulator in an office setting to ablate high-grade squamous intraepithelial lesions.METHODS A retrospective review of medical records was performed on 68 human immunodeficiency virus-positive men who have sex with men who underwent infrared coagulator ablation of biopsy-proven high-grade dysplasia from the time we began using the procedure in 1999. All patients have had at least six months of follow-up. Procedures were performed with local anesthesia on patients with discrete high-grade squamous intraepithelial lesions. Follow-up consisted of anal cytology with high-resolution anoscopy and biopsy of suspicious areas every three to six months. New or recurrent high-grade dysplasia was retreated. Patients with circumferential or bulky disease were treated in the operating room and were excluded from the study.RESULTS Altogether, 68 patients met the enrollment criteria. The median patient age was 41 years (range 29–62 years). A total of 165 lesions were treated (mean 1.6 lesions, range 1–5) and only 46 (28 percent) persisted. However, 44 patients (65 percent) developed a new or persistent high-grade squamous intraepithelial lesion within a median time of 217 days (range 27–566 days) after infrared coagulation. The remaining 24 patients (35 percent) were free of high-grade dysplasia for a median of 413 days (range 162–1313 days) after infrared coagulation. When patients were treated a second or third time, the incidence of new or persistent high-grade dysplasia dropped to 58 percent and 40 percent, respectively. The probability of curing a retreated lesion was 72 percent. Using generalized estimating equations, the incidence of high-grade dysplasia decreased with repeated infrared coagulator treatments. No patient developed squamous-cell carcinoma, had a serious adverse event, or developed anal stenosis.CONCLUSIONS The infrared coagulator is a safe, office-based modality for treating anal high-grade squamous intraepithelial lesion in human immunodeficiency virus-positive men who have sex with men. Successive treatments led to decreased recurrence rates.This retrospective chart review was performed on patients treated at the first authors surgical practice in New York City. It was supported in part by supply of the infrared coagulator furnished by Redfield Corporation, Rochelle Park, New Jersey. Adam Kawaleks participation was partially funded through the Mount Sinai School of Medicine Alumni Summer Research Fellowship.Read at the meeting of The American Society of Colon and Rectal Surgeons, Dallas, Texas, May 8 to 13, 2004     

浙江省杭州市西湖区男男性行为人群HIV感染情况及影响因素分析

目的 了解浙江省杭州市西湖区男男性行为人群（MSM）同性性行为特征、感染风险情况、HIV感染情况及影响因素分析。方法 本项目采用滚雪球和同伴推荐的非概率抽样方法在非政府组织中招募研究对象进行问卷调查,采用唾液快检试剂进行初筛,蛋白印迹试验（WB）进行实验室确证,logistic回归用于调查对象HIV感染影响因素的分析。结果 共调查1 906人,唾液快检试剂检测结果显示有96人（占5.04%）HIV抗体阳性,阳性告知率89.63%;最终HIV确证阳性45人（占2.36%）,阳性告知率100.00%。仅有110人（5.77%）每次发生性关系前知道对方HIV感染状况,1 054人（占55.30%）对在发生性关系前是否了解对方HIV感染情况持无所谓态度,649人（34.05%）认为自己不可能感染HIV,1 079人（56.61%）没想过这个问题。多因素logistic回归分析结果显示,近6个月与男性发生性交时从不使用安全套（OR=4.545,95%CI:1.093~18.894）、近6个月与男性发生性交时有时使用安全套（OR=3.134,95%CI:1.133~8.666）、从未做过HIV抗体检测（OR=37.027,95%CI:10.928~125.459）、只做过1~2次HIV抗体检测（OR=12.291,95%CI:3.338~45.254）、没有想过HIV感染风险问题（OR=5.792,95%CI:2.271~14.771）是HIV感染的危险因素。结论 推广安全套的使用,提高艾滋病感染风险意识,并且提高快检试剂初筛阳性人群的确诊比例是当前西湖区MSM艾滋病防治工作的重点。     

The Use of Rectal Douches among HIV-uninfected and Infected Men who Have Unprotected Receptive Anal Intercourse: Implications for Rectal Microbicides

Although some rectal douches result in surface epithelium loss and potential increase of HIV transmission, men who have sex with men (MSM) continue to use them. We describe the prevalence of this practice among MSM engaging in unprotected receptive anal intercourse (URAI) in risky circumstances. A multiethnic sample with overrepresentation of HIV-negative MSM who had URAI in the previous year was recruited exclusively through the Internet. Participants were 105 MSM (78 HIV-negative, 27 HIV-positive). A total of 53% of HIV-negative and 96% of HIV-positive men douched in preparation for sex, most of them frequently or always, mainly for hygienic purposes. 27% of HIV-negative and 44% of HIV-positive douched after sex, partly believing douching protected from infections. Douching practices started around age 25. Regression analyses found the association between HIV status and douching occasions persisted after controlling for demographic characteristics and number of URAI occasions. Rectal douching in preparation for sex is common among men who practice URAI. This population could benefit from alternatives to condoms, such as rectal microbicides. Given the popularity of pre-coital douching and its frequency, a harmless rectal douche that could deliver a rectal microbicide could have great acceptability.     

Co-factors affecting substance abuse among homosexual men: an investigation within a midwestern gay community

In an effort to begin formation of an empirically based model of gay substance abuse, this study examined the effects of three psychosocial factors, homosexual identity formation, self-esteem and a familial history of substance abuse in the evolution of this phenomenon among homosexual men, a group that appears to manifest appreciably higher rates and concomitantly greater associated problems than the general population. Data were obtained by voluntary subject return of a self-report instrument that was distributed widely over a 6 month period in the metropolitan Cleveland area, resulting in a moderately sized sample. Although the sampling method limited the generalizibility of the results, diminished self-esteem and a familial history of substance abuse had significant associations with both alcohol and drug abuse and were confirmed to be salient predictors, together accounting for almost half the variance in alcohol abuse and over one-third the variance in drug abuse. Moreover, both had the ability to significantly discern between alcohol and drug use groups versus groups found to be alcohol and drug abusive. Levels of a gay identity were not meaningfully associated with substance abuse. Finally, recommendations for further research were explicated.     

乘数法在艾滋病高危人群基数估计中的应用

目的 探讨乘数法在艾滋病高危人群(暗娼人群、静脉吸毒人群、同性恋人群)基数估计中的运用。方法 运用乘数法对艾滋病高危人群进行估计。结果 乘数法对绵阳市市区女性商业性性工作者和乐山市市区静脉吸毒人群的估计分别为5080人和1703人，未能对成都市市区同性恋人群基数做出较好估计。结论 运用乘数法对艾滋病高危人群进行估计实施简易，结果可信，但需注意乘数法的适用人群和实施注意事项。     

Neuroendocrine contributions to sexual partner preference in birds

A majority of birds are socially monogamous, providing exceptional opportunities to discover neuroendocrine mechanisms underlying preferences for opposite-sex partners where the sexes form extended affiliative relationships. Zebra finches have been the focus of the most systematic program of research to date in any socially monogamous animal. In this species, sexual partner preference can be partially or largely sex reversed with hormone manipulations during early development, suggesting a role for organizational hormone actions. This same conclusion emerges from research with Japanese quail, which do not form long-term pairs. In zebra finches, social experience manipulations during juvenile development also can sex reverse partner preference, either alone or in combination with an early hormone manipulation. Although there are several candidate brain regions where neural mechanisms could underlie these effects of hormones or social experience, the necessary research has not yet been done to determine their involvement. The neuroendocrinology of avian sexual partner preference is still frontier territory.     

Is Stapled Hemorrhoidopexy Safe for the Male Homosexual Patient? Report of a Case

Stapled hemorrhoidopexy is becoming a widely accepted surgical treatment for third- and fourth-degree hemorrhoids because it is associated with much less postoperative pain than open hemorrhoidectomy. After the procedure, a circular line of staples is left in the anal canal; therefore, there is a risk of penile injury or condom damage during anal intercourse, which increases the risk of exposure to sexually transmitted diseases. We report the case of a male homosexual patient who engaged in anal intercourse after recovering from a stapled hemorrhoidopexy, resulting in condom damage. We did not consider this possibility and neglected to discuss the issue with the patient. With an estimated 2.5% of the general population being exclusive, male homosexuals, it is necessary to inform such patients to refrain from anal intercourse after hemorrhoidopexy, although there are no reports stating how long this restraint should last.