Risk of AIDS in HIV seroconverters: A comparison between intravenous drug users and homosexual males

A multicentre cohort study was conducted in Italy to estimate the risk of developing AIDS in 261 intravenous drug users and 89 homosexual males for whom the seroconversion period was known.Four years after HIV seroconversion, AIDS incidence, estimated by Kaplan-Meier survival technique, was 13.8% for intravenous drug users and 16.2% for homosexual males; the difference was not statistically significant.These findings suggest that four years after seroconversion the risk of developing AIDS in HIV seropositive intravenous drug users is no higher than that of subjects who acquired HIV infection through sexual contact.Corresponding author.     

Test of HIV incidence shows continuing HIV transmission in homosexual/bisexual men in England and Wales

It has been suggested that HIV incidence will decrease with the increased use of antiretroviral Therapy (ART) in HIV infected homosexual/bisexual men. HIV incidence was measured using a sensitive/less sensitive assay technique, at a time when combination ART was widespread. The Serological Testing Algorithm for Recent HIV Seroconversion (STARHS)13 technique was applied to syphilis test specimens collected from homosexual/bisexual men attending 15 sexually transmitted infections (STI) clinics which participated in an unlinked anonymous serosurvey of HIV infection during 1998. The HIV incidence rate was adjusted to compensate for patients who had a repeat syphilis test within the same year. Leftover syphilis test sera from 6202 men had been unlinked and anonymised, of which 415 were HIV positive. Sera from 412 (99.3%) patients were available. The STARHS assay showed 62 to have been recently infected with HIV (approximately in the last four months), giving an incidence of 3.33% per annum (95% CI: 2.06%-5.27%). The highest incidence was seen in those aged 35-44 years. About 46% of all HIV-infected homosexual/bisexual men were probably receiving combination ART at this time. If 10% of those on treatment were misclassified as recent infections the incidence would have been 2.58% per annum (95% CI: 1.53%-4.24%). In homosexual/bisexual men having syphilis tests at STI clinics in the UK during 1998 the incidence of HIV infection was between two and three per hundred per year. Treatment with combination ART of almost a half of homosexual/bisexual men who are HIV infected in the population is compatible with appreciable continuing HIV transmission among those at high behavioural risk. Public health surveillance systems for those at high risk for HIV infection should, as soon as possible, incorporate the STARHS methodology for monitoring recent HIV incidence.     

HIV infection and sexual behaviour among homosexual and bisexual men in Bratislava

OBJECTIVE: To determine sexual behaviour and HIV prevalence in a sample of homosexual and bisexual men in Bratislava. PATIENTS AND METHODS: Participants were recruited at gay discotheque in Bratislava in February and June 1996. Saliva samples were collected for testing the presence of anti-HIV antibodies and a questionnaire regarding sexual practice was completed. RESULTS: In the study 170 men (1st discotheque) and 124 men (2nd discotheque) were enrolled. The prevalence of antibodies against HIV was 5.4% and 1.6%, respectively. A group of 119 attenders (mean age: 25 years) was voluntarily questioned about their sexual lifestyle and related behaviour. Sexual orientation of participants was following: 66.4% homosexuals, 20.2% bisexuals, 13.4% others. Most responders were single and did not ever been married (86.55% vs. 12.6%, respectively). The figures of sexual intercourse were: steady partners: 45.38%, non-steady partners: 49.58%. More individuals were using condoms (70.58% vs. 15.97%, respectively), while only 28.57% were using them by each chance sexual intercourse. 6.7% responders suffered from an other STD and 3.36% were intravenous drug users. CONCLUSION: The HIV prevalence (5.4% and 1.6%) was relatively low. Considering the high prevalence of unsafe sexual practice further spread of HIV infection among homosexual men in Slovakia is to be expected.     

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.     

History of childhood sexual abuse and HIV risk behaviors in homosexual and bisexual men

OBJECTIVES: We examined the prevalence and frequency of childhood sexual abuse and their association with sexual risk among a sample of gay and bisexual men. Methods. Cross-sectional data were collected by survey from randomly selected gay and bisexual men who attended the 1997 and 1998 Minneapolis/St. Paul Gay, Lesbian, Bisexual, and Transgender Pride Festivals. Data included demographics, sexual activity, history of childhood sexual abuse, HIV status, history of sexually transmitted infection, use of sex-related drugs (such as crack, cocaine, Ecstasy, amyl nitrate, crystal methamphetamine, and Special K), and history of exchanging sex for payment. Results. childhood sexual abuse was reported by 15.5% of the survey respondents (n = 134). Those who reported experiencing abuse regularly were more likely to (1) be HIV positive, (2) have exchanged sex for payment, and (3) be a current user of sex-related drugs. Neither unsafe sex nor sexually transmitted infections were associated with childhood sexual abuse. CONCLUSIONS: These findings show that more than 1 in 7 gay and bisexual men in a non-clinical, festival-based setting were victims of childhood sexual abuse and that childhood sexual abuse was associated with alarmingly high rates of men who were HIV infected and antecedent risk behaviors.     

Association between exercise and HIV disease progression in a cohort of homosexual men

PURPOSE: To study the relationship between exercise and human immunodeficiency virus (HIV) disease progression. METHODS: 415 individuals (156 HIV positive, 259 HIV negative), from a cohort study of 851 homosexual men from New York City, 1985-1991. By 1991, 68 of the 156 persons developed Acquired Immune Deficiency Syndrome (AIDS) and 49 died with AIDS. Exercise was defined as self-report of exercising 3-4 times/week or daily at entry; less was considered nonexercise. CD4 lymphocyte decline was constructed for each subject by modeling log CD4 count against time in days. The association between exercise and progression to AIDS and death with AIDS, adjusting for baseline CD4 count, was determined using Cox model. Linear regression was used to model CD4 decline with exercise for HIV positive and HIV negative groups separately, adjusting for initial CD4 count. RESULTS: Having exercised was associated with slower progression to AIDS at 1 year (HR = 0.68, 90% confidence interval (CI): 0.4-1.17); hazard ratios (HR) at 2, 3, and 4 years were 0.96, 1.18, and 1.36, respectively. Having exercised was also associated with slower progression to death with AIDS at 1 year (HR = 0.37, 90% CI: 0.14-0.94) with hazard ratios at 2, 3, and 4 years of 0.68, 0.98, and 1.27, respectively, suggesting a protective effect close to the time exercise was assessed, but an increased risk after 2 years. Exercising 3-4 times/week had a more protective effect than daily exercise. Exercisers in the HIV positive group showed an increase in CD4 count during a year by a factor of 1.07. CONCLUSION: Moderate physical activity may slow HIV disease progression.     

Behavioral interventions for the primary prevention of HIV infection among homosexual and bisexual men

Behavioral intervention is the most urgent priority in preventing the further spread of HIV. To maximize the efficacy of AIDS prevention and to most efficiently allocate resources, it is imperative that variables contributing to preventive behavior change be accurately identified, and interventions be critical evaluated prior to widespread dissemination. We review studies regarding homosexual/bisexual men in terms of: 1) epidemiological trends in HIV transmission; 2) models of behavior change organized around the initiation, consolidation, and maintenance of change, and; 3) preventive intervention outcomes. We conclude with recommendations for effective primary prevention programs.Peggy L. Peterson is affiliated with the School of Social Work, Social Development Research Group, University of Washington. Address correspondence and reprint requests to: 146 North Canal St., Suite 211, XD-50, Seattle, WA 98103.David G. Ostrow is affiliated with the University of Michigan.David J. McKirnan is affiliated with the University of Illinois at Chicago.     

静脉药瘾者HIV重叠HBV/HCV感染研究

目的探讨人类免疫缺陷病毒（HIV）重叠乙型肝炎病毒（HBV）/丙型肝炎病毒（HCV）感染时,HIV对机体T辅助细胞亚群的影响及HBV/HCV核酸载量的变化.方法以静脉药瘾者（IVDUs）为研究对象,采用ELISA、免疫层析法和PCR法检测病毒感染指标,用ELISA法和间接免疫荧光法检测T细胞亚群.结果 IVDUs的CD3、CD4细胞、干扰素（IFN）-γ和白细胞介素（IL）-4产生减少,IVDUs存在HIV感染时CD3、CD4细胞和IFN-γ产生进一步降低,HIV感染与HBV-DNA和HBeAg表达相关.结论 IVDUsT细胞亚群功能减弱,HIV促进HBV复制,重叠感染可进一步干扰辅助性T细胞（TH）1/T2细胞平衡,降低机体细胞免疫功能.     

Mortality of intravenous drug users in Rome: a cohort study.

A historical cohort study was carried out in Rome to examine overall and cause-specific mortality among intravenous drug users (IVDUs). A total of 4200 IVDUs (3411 men and 789 women) enrolled in methadone treatment centers between 1980 and 1988 were studied. There were 239 deaths during the follow-up period. The overall SMR was 10.10 in the entire cohort (95% confidence interval, 8.86-11.47), 9.30 in males and 18.07 in females. A large excess of mortality in both sexes was found for infectious, circulatory, respiratory, and digestive diseases as well as for violence, overdose, AIDS, and unknown or ill-defined causes. Tumors and suicide were excessive only in males. Deaths due to drug overdose, violence or trauma, and cirrhosis accounted for 63.6%, AIDS for 7.1%, endocarditis and other bacterial infections for 7.1%, and neoplasms for 3.8% of total mortality. These findings document serious health consequences of drug abuse in Italy.     

社区注射吸毒人群前瞻性队列5年HIV和HCV新发感染研究

目的:探索社区注射吸毒人群HIV和HCV发病率。方法:自2014年6月至2019年6月,在云南省保山市隆阳区以当地的清洁针具交换点为平台,开展前瞻性队列研究,招募社区注射吸毒者200人作为研究对象。队列每6个月进行1次随访评估,调查高危吸毒行为和性行为情况,并采集血样进行HIV和HCV血清抗体检测。采用开放队列,每12...     

The San Francisco Men''s Health Study: continued decline in HIV seroconversion rates among homosexual/bisexual men.

The incidence of infection by the human immunodeficiency virus (HIV) has been monitored since 1984 in an area probability sample of homosexual/bisexual men drawn from a six-kilometer square area of San Francisco where the epidemic of acquired immunodeficiency syndrome (AIDS) has been most severe. Annualized HIV seroconversion rates in previously uninfected cohort members have declined by 88 per cent from 5.9 per cent during the first six months of 1985 to 0.7 per cent during the last six months of 1987. Concurrent declines of approximately 80 per cent in the prevalence of sexual behaviors associated with HIV transmission were also observed in the sample.     

Decreased incidence in HIV infection and changed sex behavior in a cohort of homosexual men in Amsterdam

Prevalence and incidence of HIV were studied in two cohorts of homosexual men in Amsterdam between 1980 and 1987. The cumulative incidence of HIV infection increased from a weighted 2.2% in 1980 to 39% in 1987. In that year the observed incidence was less than 1%. The estimated annual HIV incidence was 3% in 1981, rose to 8.8% in 1984 and decreased gradually to 0% in 1987. This decline was assumed to be linked to a strong reduction of high risk sexual behaviour among the men under study.     

HIV感染的吸毒人群的艾滋病知识和行为调查

目的了解有吸毒史的艾滋病病毒（HIV）感染者的艾滋病知晓情况、吸毒行为、性行为特征,为HIV/AIDS干预提供合理依据。方法采用横断面调查,于2009年4～8月,对澜沧县109名有吸毒史的HIV感染者进行面对面的调查,用SPSS13.0进行统计分析。结果 109名吸毒者中,20～40岁年龄组占74.31%,小学和初中分别占38.53%和33.03%,农民67.89%,少数民族66.06%。艾滋病知识总体知晓率为84.40%,不同文化程度、婚姻状况的人艾滋病知识知晓率差异有统计学意义（χ^2值分别为8.49,9.18;P值分别为0.037,0.027）;2009年4～8月期间,有7人曾共用注射器吸毒;46人与固定性伴有性行为,其中32.61%的人坚持使用安全套;4人与非商业非固定性伴有不安全性行为;8人与异性商业性伴有过性行为,5人未坚持使用安全套。结论有吸毒史的HIV感染者共用针具行为、多性伴和不安全性行为仍然存在,提示应采取宣传教育和行为干预并重的预防措施。     

A patient infected with HIV as a result of intravenous drug misuse

This case study demonstrates that the stereotype image of drug users as being non-compliant and uncaring about their health is not always correct. This article demonstrates that it is possible to promote weight gain in a patient infected with HIV as a result of intravenous drug misuse with a rather chaotic, addictive life-style.
This patient gained a significant amount of weight, even after being diagnosed as suffering from AIDS 3 years previously, and continues to maintain his weight and have relatively few medical problems.     

Malaria in intravenous drug users associated with HIV seropositivity]

Cases of induced malaria have been notified in S. Paulo State, Brazil, in recent years. At the same time the number of cases imported from endemic regions of Brazil has been increasing. One case of induced malaria by Plasmodium vivax was registered in Presidente Prudente, located in the west of the State, in 1988 and a further eleven cases in 1989. This city is considered to be one of the main transit ports for people who come into the State from the Amazonian region. The patients declared that they had not been to any possible transmission area of malaria. All of them had, however, taken cocaine, sharing the same contaminated needle and syringe. Previously, one person with imported malaria was detected, who had transmitted the disease to the first case in 1988 and also to a further group of 3 people in 1989. One of these three latter cases then transmitted the disease to two other people. As the group of people continued to use the drug among themselves, 2 new cases arose. Afterwards, they re-infected themselves again (one of the was re-infected twice). The test for Human Immunodeficiency Virus was positive for 5 individuals, of whom one had a negative result and 2 others did not undergo the test. This information is discussed within the present context.     

Incidence and risk factors of HCV and HIV infections in a cohort of intravenous drug users in the North and East of France

In order to evaluate the incidence and risk factors of infection by hepatitis C virus (HCV) among injecting drug users (IDUs), we conducted a prospective cohort study of HCV- and human immunodeficiency virus (HIV)-negative IDUs in the North and East of France. A total of 231 HCV and HIV IDUs who had injected drugs at least once in their lifetime were followed up every 3 months over a 12-month period. Serum anti-HCV and anti-HIV were tested at inclusion in the study and at the end of the follow-up. Data on injecting practices were collected at inclusion and at each visit. Of the 231 participants included, 165 (71.4%) underwent a final HCV and HIV serum test. The incidence was nil for HIV infection and 9/100 person-years (95% CI 4.6-13.4) for HCV infection. In a multivariable analysis, we found that syringe and cotton sharing were the only independent predictive factors of HCV seroconversion.