Tuberculosis in homosexual men with HIV disease

In a 1-year period 4 cases of disseminated tuberculosis were seen among homosexual men with HIV infection. In 3 of the cases tuberculosis was the initial manifestation of defective cell mediated immunity. It is concluded that tuberculosis must be considered in any anti-HIV positive patient presenting with fever of unknown origin.     

Increased incidence of Hodgkin disease in homosexual men with HIV infection.

OBJECTIVE: To evaluate the incidence of Hodgkin disease and non-Hodgkin lymphoma among homosexual men infected with human immunodeficiency virus (HIV). DESIGN: Cohort study with computer-matched identification of participants with the Northern California Cancer Center registry. Population rate comparisons were made with data from the Surveillance, Epidemiology, and End Results (SEER) cancer registry. PARTICIPANTS: The 6704 homosexual men in the San Francisco City Clinic Cohort study. MEASUREMENTS: Incidence of Hodgkin disease, non-Hodgkin lymphoma, HIV infection, and the acquired immunodeficiency syndrome (AIDS); calculation of sex and age-adjusted standardized morbidity ratios and attributable risk. RESULTS: Eight cases of Hodgkin disease and 90 cases of non-Hodgkin lymphoma were identified through computer matching among cohort members residing in the San Francisco Bay area from 1978 through 1989. Among the HIV-infected men, the age-adjusted standardized morbidity ratio was 5.0 (95% CI, 2.0 to 10.3) for Hodgkin disease and 37.7 (CI, 30.3 to 46.7) for non-Hodgkin lymphoma. The excess risk attributable to HIV infection was 19.3 cases of Hodgkin disease per 100,000 person-years and 224.9 cases of non-Hodgkin lymphoma per 100,000 person-years. CONCLUSION: An excess incidence of Hodgkin disease was found in HIV-infected homosexual men. Additional well-designed epidemiologic studies are needed to determine whether Hodgkin disease should be considered an HIV-related malignancy.     

Pathophysiology of thrombocytopenia associated with HIV infection in homosexual men

Summary The pathophysiology of HIV associated immune thrombocytopenia (HIV-ITP) and its response to AZT was investigated. Using autologous ¹¹¹Indium-labelled platelets, platelet kinetic were analysed in two patient groups. Group 1 (untreated) was comprised of 13 patients with HIV-ITP. Group 2 (AZT) was comprised of 6 patients with a history of HIV-ITP prior to starting AZT. These patients were studied following a rise in their platelet count on AZT. Platelet survivals in both groups were shortened compared to controls, however there was no significant difference between the 2 groups. However platelet turnover rates were significantly depressed in Group 1 compared to Group 2 (P<0.05) and control values (P<0.05). The platelet count correlated with platelet turnover in Group 1 but not in AZT treated patients. Thus patients with HIV-ITP appear to have both shortened survivals and suppressed platelet production. The mechanism of the latter is unknown, but the increased turnover rate seen with AZT suggests it is a direct or indirect effect of the HIV virus.This work was supported by a grant from the National Health Research and Development Program of CanadaPresented at the International Workshop on ITP, August 26 and 27, 1988, Lucerne, Switzerland     

Sigmoidoscopic and microscopic appearance of the rectal mucosa in homosexual men.

The aims of the study were to determine what microscopic changes occur in the rectal mucosa of men who have had anal intercourse and to correlate the sigmoidoscopic and microscopic appearances. Histological abnormalities were found in 29 of 100 men who attended consecutively a sexually-transmitted diseases clinic. The histopathology of rectal gonorrhoea, as observed in 18 patients, is described as are the microscopic findings in the rectal mucosa of 10 patients with early syphilis. Of 70 men without any detectable rectal infection, biopsies from 15 (21.4%) were abnormal. Intestinal spirochaetosis was observed in biopsies from 36 of these 100 men. With the use of strict criteria to describe the macroscopic appearance of the rectal mucosa, the sigmoidoscopic findings correlated well with the histology.     

HIV enteropathy: comparative morphometry of the jejunal mucosa of HIV infected patients resident in the United Kingdom and Uganda

Aims—To compare jejunal mucosalmorphometry in HIV infected patients resident in London and Uganda.
Patients—Twenty HIV positivepatients from London and 16 from Uganda were studied, and compared withHIV negative control subjects from both sites.
Methods—Stools and biopsy specimenswere examined for enteropathogens. Surface area to volume (S:V) ratiowas estimated morphometrically, mean crypt length of jejunal biopsyspecimens was measured, and HIV infected cells detectedimmunohistochemically were quantified.
Results—Enteric pathogens weredetected in none of the London patients, and in three Ugandan patients.S:V ratio was lower, and mean crypt length higher, in the specimens ofLondon patients than in normal subjects, but there was no difference inS:V ratio or mean crypt length between Ugandan patients and controls. A negative correlation was present between S:V ratio and mean crypt length in all biopsy specimens analysed. HIV infected cells were detected only in lamina propria.
Conclusion—Infection of cells inthe lamina propria of the jejunum with HIV stimulates crypt cellproliferation, and a fall in villous surface area. The mucosal responseto HIV is masked by other pathogens in the African environment.

Keywords:HIV; jejunum; AIDS; enteropathy

     

Orogenital sex and the transmission of HIV among homosexual men.

OBJECTIVE: To investigate the possibility of orogenital transmission of HIV. DESIGN: Cohort study on HIV infection among homosexual men. SETTING: The Municipal Health Service, Amsterdam, The Netherlands. PATIENTS, PARTICIPANTS: Homosexual men for whom the date of HIV seroconversion was known (n = 102) were included in our study. MAIN OUTCOME MEASURES: Data on the sexual behaviour of our subjects in the 6-9 months preceding HIV seroconversion were collected. In order to identify those men who consistently denied practising receptive anogenital intercourse, information was retrieved from written questionnaires and from face-to-face interviews. RESULTS: Receptive anogenital intercourse in the 6-9 months before seroconversion was denied by 20 seroconverters in their written questionnaires. However, in face-to-face interviews, 11 men later reported this sexual practice. CONCLUSIONS: Orogenital transmission of HIV appears to occur, but its frequency may be overestimated because of reluctance to report the practice of receptive anogenital intercourse.     

Predictors of recent HIV testing in homosexual men in Australia

Objectives

To describe time trends and other predictors of recent HIV testing among homosexual men enrolled in behavioural surveillance studies in Australia.

Methods

Repeated cross‐sectional studies during the period 1996–2001 in Australian capital cities. Men were recruited from a variety of community‐based settings, including gay community outdoor events, sex on premises venues, and social venues. They underwent a brief self‐administered questionnaire in which they reported their HIV status, HIV‐testing history, sexual behaviour and demographic information.

Results

Questionnaires were returned for 22 161 HIV‐negative or status‐unknown participants. While 85.3% had ever tested for HIV, 57.6% had tested in the last 12 months. Recent testing was greater in those living in Sydney, in younger men, in gay‐identified men, in gay community‐attached men, in those who reported unprotected anal intercourse and a higher number of sexual partners, and in partners of HIV‐positive men. Although recent testing declined from 1996 to 2001, this trend was no longer significant when adjusted for other testing predictors.

Conclusions

In Australia, HIV testing among gay men decreased slightly from 1996 to 2001, but the trend was not significant when adjusted for other predictors. Testing levels were highest among those at highest risk of HIV infection, and lowest among non gay‐identified and non gay‐community attached homosexual men.

     

Amoebiasis in homosexual men.

The clinical, histopathological, and serological features of 35 homosexual men with infection with Entamoeba histolytica were studied and compared with a group of 35 non-infected homosexual men. Each isolate was of Zymodeme type I. Although there was no significant difference in the numbers of infected and non-infected men with gastrointestinal symptoms (48.6% and 28.6% respectively), the mean duration of symptoms was greater in with amoebiasis (p less than 0.05). The histology of the rectal mucosa was abnormal in 17 (63.0%) of the 27 men with amoebic infection only and in two (7.4%) of the 27 control subjects (p less than 0.001). Serum antibodies reactive with E. histolytica were not shown in any patient.     

Subjective HIV attribution theories,coping and psychological functioning among homosexual men with HIV

Facing a traumatic event, such as being diagnosed with HIV, the individual tries to find an explanation why the traumatic event happened. One way to answer that question is through attributions. The purpose of this study was to examine subjective attribution theories for HIV (internal/self-blame, external/blaming others, and fatalistic) and their association with coping styles and psychological functioning among 57 self-defined gay men who were HIV-positive. None of the respondents were diagnosed with AIDS. Although all men made attributions for their HIV infection, few had incorporated exclusively self-blame and external attributions, respectively. About one-third of the gay men attributed HIV to both self-blame and external factors. Self-blame attribution was associated with the avoidant coping style. Analyses yielded that both self-blame attribution and the avoidant coping style correlated with depressive mood and life dissatisfaction. External attribution theory displayed a positive relation to depressive mood. No particular HIV attribution theory was tied to good psychological functioning. The clinical implications of these results are discussed.     

Frequent oropharyngeal shedding of Epstein-Barr virus in homosexual men during early HIV infection.

OBJECTIVE: To determine the frequency of Epstein-Barr virus (EBV) oropharyngeal shedding during HIV infection in homosexual men in the Multicenter AIDS Cohort Study. DESIGN: The cohort consisted of 210 men who were HIV-seronegative at their baseline study visit, 39 of whom seroconverted to HIV at a later date, and 73 asymptomatic and mildly symptomatic men with HIV infection of indeterminate duration. METHODS: EBV in throat washings was detected by transformation of newborn cord blood lymphocytes. RESULTS: EBV was isolated from 49% (35 out of 71) of the HIV-seropositive and 16% (33 out of 204) of the HIV-seronegative homosexual men tested at their baseline visit. Elevated EBV shedding frequency was noted 6 months before, as well as during the first HIV-seropositive clinic visit, in the men who seroconverted to HIV. Seronegative men who shed EBV at their baseline visit seroconverted to HIV within a shorter period than did non-shedders during 5 years of follow-up. Shedding of EBV was not significantly associated with either abnormal T-cell numbers, clinical symptoms or risk for development of AIDS. CONCLUSIONS: There is an increased rate of EBV shedding in HIV-seropositive homosexual men that occurs very early in the course of HIV infection.     

Anogenital infection with Neisseria meningitidis in homosexual men.

Among monosexual men anal infection with Neisseria meningitidis was more prevalent (15 of 731 men) than expected and significantly more prevalent than urethral infection with N. meningitidis (three of 669 men, P less than 0.01). Anal infection was also significantly more prevalent among homosexual men than among heterosexual women (two of 1,197 women, P less than 0.001). These differences in rates of prevalence may be best explained by a preference of meningococci for anal mucosa and by the common homosexual practice of oral-anal sexual contact. Serogrouping of the 17 anal and three urethral isolates revealed a broad representation of serogroups often found in meningococcal pharyngeal carriage in the community. Of 14 patients who returned for a test-of-cure culture within seven days of treatment with an antibiotic regimen recommended for anogenital gonococcal infection, each was culture-negative for N. meningitidis. Minor and symptoms in three men and profuse urethral discharges in two men resolved with treatment.     

Nodular lymphoid hyperplasia of the jejunal mucosa associated with hypogammaglobulinemia. Increased number of mast cells in the jejunal mucosa

A case with nodular lymphoid hyperplasia of the jejunal mucosa associated with hypo- and dysgammaglobulinemia, increased susceptibility to infections, recurrent giardia invasions, absence of plasma cells in the bone marrow and jejunal mucosal stroma and extremely increased number of mucosal mast cells has been described. The latter was supposed to be an essential morphological feature of the syndrome, that is due to a "secondary" response to repeated giardia invasions in a condition of impaired humoral but presumably normal cellular immune response. Some of the tinctorial properties of intestinal mucosal mast cells were discussed.     

Effect of HIV antibody disclosure on subsequent sexual activity in homosexual men

During a prospective study of the natural history of AIDS, 1001 homosexual or bisexual men were offered the opportunity to learn their HIV antibody status. Six hundred and seventy (67%) of the population who elected to do so were similar to the 331 (33%) people who declined in a number of baseline characteristics. All were counselled to practice safe sex. To determine whether disclosure of HIV serologic status affects subsequent sexual behavior, we examined changes at four time-points in three sexual activities during the previous 6 months: the number of male partners with whom the participant had (1) sexual intercourse, (2) unprotected anal receptive intercourse, and (3) unprotected anal insertive intercourse. All activities decreased strikingly over the 18-month study period. Following disclosure, the mean number of partners dropped to 47% of the baseline number in people remaining unaware of their antibody status, to 45% in people told that they were seropositive, and to 55% in people told that they were seronegative. The mean number of partners for younger seropositives declined less than that for older seropositives. The mean number of partners with whom unprotected anal receptive intercourse was practiced declined to 57% of baseline in unaware people, 42% in aware seropositives, and 62% in aware seronegatives. The mean number of partners with whom unprotected anal insertive intercourse was practiced declined to 52% of baseline in unaware people, 42% in aware seropositives and 59% in aware seronegatives. Disclosure of a negative test result led to a significantly smaller decline in these sexual activities.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prevalence of thrombocytopenia in HIV-infected and non-HIV infected drug users and homosexual men

We studied the prevalence and risk factors for thrombocytopenia among 299 drug users and 461 homosexual men. The prevalence of thrombocytopenia was 3.3% in HIV-negative homosexual men, 8.7% in HIV-negative drug users, 16.4% in HIV-positive homosexual men, and 36.9% in HIV-positive drug users. With multivariate logistic regression HIV-seropositivity (odds ratio 3.3), a history of injecting drugs (OR 3.9), an increased number of lymphocytes (OR 0.44), an increased number of neutrophils (OR 0.53) and a larger mean platelet volume (OR 2.8) were independently and significantly associated with thrombocytopenia. The results obtained with linear regression analysis were consistent with the results of the logistic regression. The higher prevalence of thrombocytopenia among drug users was related to a history of intravenous drug use but not to recent injecting. The mechanisms causing thrombocytopenia among HIV-positives and HIV-negatives seem to be related, but HIV-infection seems to enhance thrombocytopenia in an independent way.