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.     

Predictors of unprotected male-to-male anal intercourse with casual partners in a national sample

Abstract: The focus of the paper is the predictors of unprotected anal intercourse with casual partners among a national Australian sample of homosexually active men. We interviewed by telephone 2583 homosexually active men (sex with a man within the last five years) about their sexual practice, type of sexual partners, human immunodeficiency virus (HIV) test status, attachment to the gay community, knowledge of HIV and acquired immune deficiency syndrome (AIDS) and a range of demographic variables. Logistic regression analyses were used to distinguish men who practised unprotected anal intercourse with casual partners from those who practised safe sex with casual partners. Men who practised unprotected anal intercourse with casual partners were less likely to have a regular male sexual partner than men who practised safe sex with their casual partners. They were less likely to be tertiary educated, more likely to be employed in trade and manual occupations and to live in Tasmania and the Northern Territory. They were less likely to be culturally or politically attached to the gay community. Knowledge of HIV/AIDS also distinguished the men: men with an accurate knowledge of HIV transmission were less likely to engage in unprotected anal intercourse with their casual partners. Several other variables, including age and HIV test status, did not distinguish those who practised safe sex with casual partners from those who practised unprotected anal intercourse with casual partners.     

Type of alcohol and drinking pattern in 56, 970 Danish men and women

OBJECTIVE: To describe drinking patterns among individuals who prefer drinking wine, beer or spirits. DESIGN: Cross-sectional study obtaining detailed information on intake of wine, beer and spirits and on frequency of alcohol intake. Adjustment for gender, age, smoking habits, educational attainment and body mass index. SETTING: Denmark. SUBJECTS: 27, 151 men and 29, 819 women, randomly selected from Copenhagen and Aarhus, Denmark. MAIN OUTCOME MEASURES: Drinking pattern-steady or binge drinking. RESULTS: A vast majority (71%) of both men and women preferred wine or beer. At all levels of total alcohol intake, beer drinkers were most likely to be frequent drinkers. Thus, light drinkers of beer had an odds ratio for being frequent drinkers of 1.97 (95% confidence limits 1.50-2.58) as compared to light drinkers of wine (total alcohol intake 3-30 drinks per month), while people who preferred beer had an odds ratio of 1. 29 (1.19-1.40) compared with wine drinkers in the moderate drinking category (31-134 drinks per month). There were no significant differences in total alcohol intake between individuals preferring different alcoholic beverages. CONCLUSION: If binge drinking is less healthy than steady drinking, the relation between wine intake and coronary heart disease mortality could be subject to negative confounding, since beer drinkers seem to have the most sensible drinking pattern. SPONSORSHIP: Danish Cancer Society and the Danish National Board of Health. European Journal of Clinical Nutrition (2000) 54, 174-176     

Risk factor analysis among men referred for possible acquired immune deficiency syndrome

Responses to a lifestyle questionnaire among 13 patients with Kaposi's sarcoma and 18 with an opportunistic infection were compared with those of 29 symptom-free referred individuals. Odds ratios (OR) with 95% confidence limits were calculated as an estimate of risk. Significantly elevated odds ratios (P less than 0.05) were found for cigarette smoking (OR = 3.4), marijuana use (OR = 3.7), nitrite use (OR = 5.5), frequenting bathhouses (OR = 7.6), prior syphilis (OR = 3.4), and fist-rectal sexual practices (OR = 3.5). A response gradient for the risk estimates was found for marijuana use (OR = 2.7 for occasional, OR = 4.3 for frequent use); nitrites (OR = 4.0 for occasional; OR = 6.3 for frequent use); and prior syphilis (OR = 2.9 for one to two previous infections and 9.0 for three or more). We believe the evidence is now sufficient to recommend preventive practices which may reduce the male homosexual's risk for developing acquired immune deficiency syndrome, Kaposi's sarcoma, and/or opportunistic infections. These include cessation of cigarette smoking, marijuana use, and nitrite inhalation; reduction in number of anonymous sexual partners to decrease risk of sexually transmitted diseases; and avoidance of fisting.     

Time of exposure and risk of HIV infection in homosexual partners of men with AIDS.

We interviewed, and tested for HIV antibody, 117 homosexual men who had been regular sexual partners of men who developed acquired immunodeficiency syndrome (AIDS); 85 tested seropositive. Receptive anal intercourse with the index AIDS case and number of different sexual partners with whom subjects were anally receptive were both risk factors. Controlling for the number of partners with whom subjects were anally receptive, we found that the odds ratio of receptive anal intercourse with the case was infinite (95% confidence intervals, 3.3-infinity) if sexual contact continued up to or beyond the time of diagnosis, while the odds ratio was 1.0 (95% CI 0.3-3.2) if contact ceased before the case's AIDS diagnosis. Risk was not associated with the duration or frequency of contact. Our data suggest that the potential for sexual transmission from an HIV-infected person may be greater close to or after the onset of disease.     

120例男男性接触者行为学特点分析

目的了解北京地区男男性接触者(MSM)行为特点,为深入开展行为干预提供依据。方法通过活跃在本市的一个MSM联系组织,用网上发布消息和互相转告的方式召集调查对象,在知情同意的基础上现场进行问卷调查。结果通过对120人有效问卷进行统计,结果显示,最近3个月内有3个及以上同性性伴的人数占75.84%,3个月内发生肛交性行为中每次都用安全套比例仅为16.86%,最后一次肛交性行为中40.83%未使用安全套,9.17%使用中发生破裂,有41.67%的人有过群交性行为,24.2%的人曾患性病,最多一人患4种性病,4人吸毒。结论通过对北京地区120例MSM人群性活动调查显示:性活动活跃,性伴多,安全套使用率低,该人群中引起艾滋病发生流行的因素广泛存在。     

Age of partners at first intercourse among Danish males and females

In 1984–1985 a representative sample of 286 Danish women (response rate = 75.3%) and 336 Danish men (response rate = 77.8%), ages 16–20 years, was interviewed about their first sexual intercourse. A cumulative frequency function was constructed and the median age at sexual debut was estimated at 16.8 years for both male and female. Generally the age difference between the partners at first intercourse was only a few years. However, the young women almost never reported their first sexual partner as younger than themselves. A cross-check was made of the information given by two homogeneous subsamples of the 47 young women and 80 young men who had their first sexual intercourse with a partner who was also a debutant. Self-reported age among the males differed significantly from the age of the first sexual partner as stated by the females in these subsamples. Therefore, there is bias in the reporting of age of partner at first intercourse. As the self-reported age at first sexual intercourse by young women agrees with the age of first partner as stated by young men, the bias seems to manifest itself predominantly as a systematic misreporting in the age of male partners of debutant females.This work supported by a research grant from Sygekassernes Helsefond.     

AIDS and sexual behavior reported by gay men in San Francisco.

In November 1983, we surveyed 655 gay men in San Francisco regarding their sexual practices during the previous month and the same month one year ago. The sample was selected to include men in situations that would lead to high risk of sexual activities related to AIDS (acquired immune deficiency syndrome) transmission (i.e., men frequenting bathhouses and gay bars) as well as men in low-risk situations (those going to neither place and men in primary relationships). The Bath group showed little change in frequency of bathhouse use and in number of sexual partners from that location. The other groups showed substantial reductions in frequency of sexual contacts from bars, baths, T-rooms, or parks. Men in monogamous relationships showed little change in sexual behavior within their relationship. Men in non-monogamous relationships and men not in relationships reported substantial reductions in high-risk sexual activity, but not a corresponding increase in low-risk sexual behavior. Knowledge of health guidelines was quite high, but this knowledge had no relation to sexual behavior. Using sex to release tension, use of sex to express gay identity, and knowledge of persons with AIDS in the advanced stages of disease were related to frequency and type of sexual behavior.     

AIDS-associated Kaposi's sarcoma: 22 cases

BACKGROUND: Kaposi's sarcoma is the most common acquired immune deficiency syndrome (AIDS)-associated malignancy. Our aim was to analyse the epidemiological, clinical, therapeutic findings in AIDS patients with Kaposi's sarcoma. METHODS: This was a retrospective chart review of AIDS patients with Kaposi's sarcoma diagnosed between 1991 and 2005. Epidemiological data, the stage of human immunodeficiency virus's (HIV) infection, clinical characteristics of Kaposi's sarcoma, treatment rendered and outcome were collected. The search of HHV8 was not done. RESULTS: Twenty two patients were included. They were 17 men and 5 females (sex-ratio=3.4/ 1) with a mean age of 33.6 years at the diagnosis of HIV infection. The Kaposi's sarcoma appeared after a period varying between 0 and 10 years. The Kaposi's sarcoma uncovered the infection in 5 cases. There were 6 homosexual men. The mean rate of CD4 was 216 21/mm3 at the diagnosis of Kaposi's sarcoma. All patients had skin lesions. Mucocutaneous lesions were isolated in 12 cases and associated with visceral involvement in 10 cases; lung (10 cases), gastrointestinal tract (5 cases), lymphadenopathy (5 cases), liver (4 cases), spleen (2 cases). Antiretroviral therapy was prescribed for 13 patients. Six patients received chemotherapy and 3 others radiotherapy. Outcome was favourable in 4 cases with a partial improvement of the skin lesions in 3 cases and a complete regression in 1 case. Twelve patients died. CONCLUSION: AIDS associated Kaposi's sarcoma is a severe condition because of visceral localisations and the field of immunodeficiency. It requires a precocious diagnosis and collaboration. The identification of HHV8 in the aetiopathogenic mechanism of Kaposi's sarcoma can lead to the development new therapeutic approaches.     

The gay report on sexually transmitted diseases.

Most studies of sexually transmitted diseases in homosexual men have examined prevalence in clinic populations; for comparative purposes, we analyzed data from a survey of 4,329 gay men conducted in 1977. Among 4,212 respondents to the self-administered questionnaire, 66.8 per cent reported previous infection with pediculosis; 38.4 per cent, gonorrhea; 24.1 per cent, nonspecific urethritis; 18.1 per cent, venereal warts; 13.5 per cent, syphilis; 9.7 per cent, hepatitis; and 9.4 per cent, herpes. Number of different lifetime sexual partners best predicted histories of symphilis (r = .249), gonorrhea (r = .402), and the other diseases; frequency of checkups, years as a practicing homosexual, and furtive sexual activities were among the many other significant correlates of venereal infections. Respondents most often sought examinations from private physicians (39.4 per cent); those who visited gay clinics were examined most often and felt most positive about their medical care. Gay men who participated in the survey reported frequent infections with many of the same sexually transmitted diseases often seen in private medical practices, public VD clinics, and gay health centers. Since high rates of disease are related to large numbers of different partners, frequent exposures with anonymous contacts, and anal intercourse, we recommend frequent examinations for those whose life-styles include these characteristics.     

Possible correlation between exposure to aids risk factors,clinical presentation in aids,and subsequent prognosis

AIDS-related Kaposi's sarcoma (KS) has a better prognosis than other presentations of AIDS. It is more frequent among homo-bisexual men than in other risk groups. This has raised the possibility of specific etiological agent(s) or co-factor(s) which induce its development. However, this suggestion is confusing since it implies that exposure to such agent(s) or co-factor(s) would result in an improved prognosis. Recent virological studies indicate that the HIV itself could be responsible for the induction or growth of KS. Since HIV antigenemia and the immunosuppression are lower among KS cases than among those with opportunistic infections (OI), we could expect a lower level of exposure to AIDS-related factors in KS cases as compared to OI cases.To investigate this possibility, we compared 25 cases with Kaposi's sarcoma alone (KS) with 25 cases having OI without KS, among homo-bisexual men.The KS cases were more likely than OI cases to have a higher educational level. They were less likely to have inhalated nitrites, to have had repeated syphilis and repeated gonorrhoea, and to be promiscuous. In the multivariate analysis, the factors which best discriminated the groups were nitrite inhalations, history of repeated syphilis, and anonymous promiscuity (one-night stands).Our study does not support the hypothesized association between nitrite inhalations and Kaposi's sarcoma. We found that cases with opportunistic infections - that is, with a poor prognosis — had been exposed to AIDS-related risk factors (e.g. history of venereal diseases, nitrite inhalations, promiscuity) at higher levels than cases with Kaposi's sarcoma alone. Our results are in agreement with the demostrated higher antigenemia and higher immunosuppression of OI cases, and suggests that the prognosis of AIDS could be associated with the level of exposure to AIDS risk factors or cofactors.Corresponding author.     

Frequency of sexual problems and sexual dysfunction in middle-aged Danish men

The frequency of sexual dysfunction of a representative group of Danish middle-aged men was recorded, using a questionnaire and an interview that contained, respectively, 12 and 23 questions about sexual problems. The study sample consisted of 439 51-year-old men, all of whom received the questionnaire. Of these men, 100 were also interviewed. Interviewed men more frequently reported erectile dysfunction and previous contact with a therapist due to sexual problems at interview than in the questionnaire. Thus, 16 men (4% of the study population) who reported erectile dysfunction in the questionnaire constituted only a fraction of the true number. At interview nearly 40% of the men reported some kind of sexual dysfunction. There were, however, only 7% who found their problems abnormal for their age—and only 5% of the interviewed men intended to seek treatment for their problems.This project was supported by the Danish National Health Insurance Foundation (Journals H 11/118-86, H 11/80-87 and H 11/137-87) and utilized the statistical service of the Danish Medical Research Council.     

Heterosexual anal intercourse: increasing prevalence, and association with sexual dysfunction, bisexual behavior, and venereal disease history

Representative samples of the Czech population were surveyed with regard to sexual behavior in 1993, 1998, 2003, and 2008 (N = 7,720). Lifetime prevalence of Heterosexual Anal Intercourse increased from 1993 to 2008 (16.6% to 19.7% among women, 15.7% to 25.3% among men). Anal intercourse was associated with lifetime number of sex partners, current masturbation, and histories (prevalence of which increased from 1993 to 2008) of homosexual sex, prostitution, venereal disease (adjusted for number of sex partners), and women's sexual dysfunction. The authors discuss the possible reasons for the increasing prevalence and the associations. Multivariate predictors of ever having a sexual dysfunction or a venereal disease are also presented.     

Diagnosis and treatment of HIV-related Kaposi's sarcoma

A 42-year-old heterosexual man presented with bluish-purple spots on his skin and in his mouth cavity that had been present for a few months; a 48-year-old homosexual man had painful lymphadenopathy in the groins and left axilla. Both men appeared to have a Kaposi's sarcoma and to be HIV-positive. During highly active antiretroviral therapy (HAART) and radiotherapy or chemotherapy, both the AIDS parameters and the skin lesions improved. Kaposi's sarcoma is AIDS-defining in HIV-seropositive patients. Human herpesvirus-8 infection seems to play a role in the development of Kaposi's sarcoma. The incidence of Kaposi's sarcoma has declined since the introduction of HAART. Nowadays, Kaposi's sarcoma is frequently the presenting symptom of HIV-seropositivity. Patients present with purple cutaneous lesions and/or generalised lymphadenopathy. Visceral lesions are associated with a shorter median survival. The treatment of Kaposi's sarcoma is palliative, whereas immune restitution can lead to regression of the sarcoma.     

Condom use and sexual habits of heterosexual intravenous drug users in Northern Italy

In order to assess modes of human immunodeficiency virus (HIVV) transmission from heterosexual intravenous drug users (IVDUs) to their partners, condom use and sexual habits with both steady and occasional partners were investigated. A total of 349 heterosexual IVDUs (247 men and 102 women) who ignored, at the time of interview, their HIV serostatus were interviewed. Respondents were asked for information on condom use and sexual habits for the three year period prior to the interview. Nearly 40% of IVDUs reported sexual intercourse with both steady partners and occasional partners. Fifty-four percent of their steady partners and 48% of their occasional partners were individuals who did not belong to groups at risk for HIV infection. Anal intercourse with steady partners was reported by 29% of IVDUs and 24% of IVDUs with occasional partners. Condom use during vaginal intercourse was seldom reported: 83% of IVDUs never used a condom with steady partners and 75% did not use one with occasional partners. IVDUs who were 1) unmarried, 2) enrolled in the study after 1986, 3) partners of not at-risk individuals, 4) partners of a foreigner and, 5) aware of their partners HIV seropositivity showed significantly higher, albeit still low, frequencies of condom use with steady partners. Conversely, all these factors seemed to have little impact on condom use with occasional partners. Condom use and sexual habits were similarly reported by HIV-positive and HIV-negative IVDUs. The present study shows that high-risk sexual behaviours among IVDUs are very widespread and it stresses the need for intensive counselling to promote condom use among IVDUs.Corresponding author.     

Evidence for a sexually transmitted cofactor for AIDS-related Kaposi's sarcoma in a cohort of homosexual men.

We examined factors associated with the subsequent development of AIDS-related Kaposi's sarcoma in a cohort of 353 homosexual men infected with human immunodeficiency virus (HIV). Cumulative incidence curves for the development of Kaposi's sarcoma and opportunistic infection were stratified over a wide range of variables at enrollment, including those related to demographics, sexual behavior, illicit drug use, and medical history. We found no strong associations between any of these variables and the development of opportunistic infection, but two were related to Kaposi's sarcoma: use of nitrite inhalants (relative risk, 2.3; 95% confidence interval, 1.0-5.0) and high numbers of sexual contacts during the period 1978-1982 in the AIDS epidemic centers of San Francisco, Los Angeles, and/or New York (relative risk, 3.5; 95% confidence interval, 1.6-7.6). The latter variables remained independently associated with risk of Kaposi's sarcoma even after multivariate adjustment for a number of classical HIV risk factors. These results are consistent with the hypothesis that Kaposi's sarcoma is caused by a sexually transmitted cofactor that has remained more prevalent in the original epidemic centers. The effect of nitrites could be due to an independent biological mechanism or to enhancement of transmission of the cofactor.     

Geographic and birth cohort associations of Kaposi's sarcoma among homosexual men in Canada

The authors conducted an analysis of all 677 cases of Kaposi's sarcoma among the 3,047 cases of acquired immunodeficiency syndrome diagnosed in homosexual/bisexual men in Canada between 1980 and 1989. The proportion with Kaposi's sarcoma declined from 32.2% during 1980-1985 to 15.0% in 1989. The proportion with Kaposi's sarcoma was significantly higher in primary epidemic centers (Vancouver, Toronto, and Montreal) and in men in the 1945-1954 birth cohort independent of year of diagnosis. These data are consistent with an environmental cofactor for Kaposi's sarcoma which is likely to be a sexually transmitted agent.     

The impact of AIDS on gay male sexual behavior patterns in New York City.

A sample of 745 gay men, ages 20 to 65, were interviewed in 1985 as part of an effort to determine the impact of the AIDS (acquired immunodeficiency syndrome) epidemic on the non-ill but at-risk community. Measured in terms of the number of different sexual partners, sexual activity was reported to have declined by 78 per cent since hearing about AIDS. The frequency of sexual episodes involving the exchange of body fluids and mucous membrane contact declined by 70 per cent, and condom use during anal intercourse increased from 1.5 to 20 per cent. Abstinence from gay sex did not change over time.     

Male influences on cervical cancer risk

Risk factors for squamous cell carcinoma of the uterine cervix were studied among low income, married Hispanic women and their husbands, using a case-control design. A total of 45 eligible cases were identified at public hospitals and community clinics in the San Francisco Bay Area. For each case, a control was selected within two years of age from among Hispanic women seen at the same institution. Thirty-nine matched pairs of couples were interviewed to assess histories of sexual behavior and other possible risk factors. Cases and controls differed markedly in the number of past sexual partners of their husbands. Cases were 5.3 times more likely to be married to husbands who had had 20 or more sexual partners than were controls. Cases and controls themselves did not differ in their number of sexual partners, but cases were younger at first intercourse than were controls. The association with husband's sexual history persisted after adjusting for the woman's number of sexual partners or age at first intercourse. These results support the infectious and venereal transmission of cervical cancer and indicate the important role of husbands in its occurrence in a population with high incidence rates.     

Ten year trends in the dietary habits of Danish men and women. Cohort and cross-sectional data

OBJECTIVE: To describe 10 year trends and individual changes in food habits of Danish men and women in relation to dietary recommendations using data from both a cohort and a repeated cross-sectional study, and to examine whether the two sampling methods give similar results. DESIGN: Baseline data were collected in 1982-1984 and respectively repeated measurements for cohort and cross-sectional changes in food habits. SETTING: The County of Copenhagen, Denmark. SUBJECTS: Men and women aged 30-70y in 1982-1984, 1986-1988 and 1992-1994. The trend analyses included 3785 subjects for cohort and 7316 for cross-sectional study, respectively. Longitudinal changes were studied among 2430 individuals with food data from all three examinations. METHODS: Food intakes were estimated using a short food frequency questionnaire. RESULTS: During the study period both men and women reported a decreased intake frequency of animal and vegetable fats, milk, eggs, meat products, white bread and potatoes, while they had increased intakes of low-fat margarine, fruit, raw vegetables, coarse breads, oatmeal, pasta, rice, cakes and candy. In both men and women the decrease in the consumption frequency of, white bread and potatoes, and the increase in pasta, and candy, were higher in the younger than in the older age group. In contrast, the increased consumption frequency of coarse breads, and oatmeal were most pronounced in the older age groups. For most foods the cohort and the repeated cross-sectional surveys gave similar results. CONCLUSIONS: From 1982 through 1994 the food habits of middle-aged Danish men and women changed in the direction of a more healthy diet as recommended by health authorities. With the limitation of a possible reporting bias both the cohort and repeated cross-sectional study designs may be used for monitoring changes in food intake.