RESUMEN
PURPOSE: To determine if the rates of malignancies other than Kaposi's sarcoma (KS) and non-Hodgkin's lymphoma (NHL) are increased in human immunodeficiency virus (HIV)-infected homosexual men. SUBJECTS AND METHODS: From 1984 through 1993, 1,199 homosexual men were studied in the Pittsburgh component of the Multicenter AIDS Cohort Study (MACS), an examination of the natural history of HIV infection. The cohort consisted of 769 HIV-seronegative (SN) participants and 430 seropositive (SP) members who were either seroprevalent at the time of enrollment or who seroconverted during the study. Cancer incidence data were collected through semiannual visits, phone interviews, medical records, and death certificates. Five thousand seven hundred eight person-years and 2,344 person-years were contributed to the study by the SN and SP men, respectively. RESULTS: In addition to 44 cases of KS, 13 NHLs, and 3 CNS lymphomas (CNSLs), 27 other malignancies occurred (three nonmelanoma skin cancers and eight other malignancies in the SP group, eight nonmelanoma skin cancers, and eight other malignancies in the SN group). Age-adjusted rates were calculated for both groups and compared with each other and with rates for the general male population in Pennsylvania. There were no differences between the SN group and the general population. Among the SP group, the combined frequency of all cancers other than KS, NHL, CNSL, and nonmelanoma skin cancers was statistically significantly increased in comparison to both the SN group and the general population. This increase was secondary to an unusually increased frequency of both seminoma and Hodgkin's disease. CONCLUSION: These findings support the hypothesis that the incidences of cancers other than KS and lymphoma are moderately increased in the setting of HIV infection and immunosuppression.
Asunto(s)
Seropositividad para VIH/complicaciones , Homosexualidad Masculina/estadística & datos numéricos , Neoplasias/epidemiología , Adolescente , Adulto , Anciano , Recuento de Linfocito CD4 , Neoplasias del Sistema Nervioso Central/complicaciones , Neoplasias del Sistema Nervioso Central/epidemiología , Estudios de Cohortes , Neoplasias de los Genitales Masculinos/complicaciones , Neoplasias de los Genitales Masculinos/epidemiología , Seronegatividad para VIH , Seropositividad para VIH/inmunología , Enfermedad de Hodgkin/complicaciones , Enfermedad de Hodgkin/epidemiología , Humanos , Incidencia , Linfoma Relacionado con SIDA/epidemiología , Masculino , Persona de Mediana Edad , Neoplasias/complicaciones , Pennsylvania/epidemiología , Sarcoma de Kaposi/complicaciones , Sarcoma de Kaposi/epidemiología , Seminoma/complicaciones , Seminoma/epidemiología , Neoplasias Cutáneas/complicaciones , Neoplasias Cutáneas/epidemiologíaRESUMEN
This analysis investigated variability of survival time in a cohort of 553 human immunodeficiency virus type 1 (HIV-1)-infected homosexual or bisexual men with < 50 CD4+ cells/microL. Median survival after the first CD4+ cell count < 50/microL was 1.34 years; 25% survived > or = 2 years. Multivariate analysis showed longer survival with concurrent acyclovir and zidovudine use, hemoglobin > or = 12 g/dL, and full-time employment (P < .0001). Other significant covariates associated with longer survival included African-American race, no prior AIDS illness, weight loss < 4.5 kg, and zidovudine use (with or without concurrent acyclovir) after CD4+ cells fell to < 50/microL. An easily derived score identified Multicenter AIDS Cohort Study subjects likely to survive > 2 years after CD4+ cell count was < 50/microL. Survival once CD4+ cell count fell below 50/microL may be longer for persons with a good performance status and specific clinical markers. Health care providers should consider these variables in decision-making strategies and design of clinical trials.
Asunto(s)
Recuento de Linfocito CD4 , Infecciones por VIH/inmunología , Infecciones por VIH/mortalidad , VIH-1 , Aciclovir/uso terapéutico , Adolescente , Adulto , Bisexualidad , Estudios de Cohortes , Infecciones por VIH/tratamiento farmacológico , Homosexualidad Masculina , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Pronóstico , Tasa de Supervivencia , Zidovudina/uso terapéuticoRESUMEN
The Centers for Disease Control reported in October 1991 that many people at risk for human immunodeficiency virus (HIV) infection had not been tested for antibodies to HIV. This study identifies differences among 110 gay and bisexual men in three small cities in Pennsylvania who decided whether to be tested for antibodies to HIV and, if so, whether to return for results. These men were given self-administered questionnaires and were offered free and confidential HIV antibody tests. Fifty percent of the men refused testing. Of those tested, only 35 percent returned to obtain test results. Contrary to other health prevention data, education was significantly and inversely related to being tested and to returning for results. Men who most often participated in the institutionalized gay community were least likely to be tested. The findings suggest that gay men who are most aware of the potential psychosocial problems associated with HIV antibody testing are more likely to avoid testing.
Asunto(s)
Bisexualidad/psicología , Toma de Decisiones , Infecciones por VIH/sangre , Conocimientos, Actitudes y Práctica en Salud , Homosexualidad/psicología , Aceptación de la Atención de Salud , Revelación de la Verdad , Adolescente , Adulto , Estudios Transversales , Escolaridad , Infecciones por VIH/epidemiología , Humanos , Modelos Logísticos , Masculino , Tamizaje Masivo/psicología , Persona de Mediana Edad , Educación del Paciente como Asunto , Factores de Riesgo , Población UrbanaRESUMEN
Because of new preventive therapies, HIV-antibody testing of asymptomatic individuals now has clear clinical benefits. Consequently, greater numbers of individuals are expected to seek testing. This article, based on the authors' experiences with disclosing HIV-antibody test results to a high-risk group of men, makes recommendations for how best to present HIV-antibody results. Disclosing HIV-antibody results provides an educational opportunity as well as a psychological challenge for clinicians. Some unusual client reactions are detailed in the case studies.
Asunto(s)
Infecciones por VIH/diagnóstico , VIH-1 , Educación del Paciente como Asunto/normas , Revelación de la Verdad , Adulto , Infecciones por VIH/enfermería , Infecciones por VIH/psicología , Humanos , Masculino , Persona de Mediana Edad , Enfermeras Practicantes/normasRESUMEN
The relative sexual transmission efficiency of hepatitis B virus (HBV) and human immunodeficiency virus type 1 (HIV-1) was investigated by a prospective study of homosexual men in Pittsburgh, Pa, from the Multicenter AIDS Cohort Study. During the 30-month follow-up, 19.8% and 7.8% of the initially seronegative HBV and HIV-1 groups were estimated to seroconvert to HBV and HIV-1, respectively. The significantly higher cumulative HBV seroconversion rate occurred despite a much lower prevalence of hepatitis B carriers (7% were hepatitis B surface antigen positive) compared with HIV-1 carriers (22% were HIV-1 antibody positive). The sexual exposure profile of HBV and HIV-1 seroconverters was similar during the 6 months prior to seroconversion, supporting the link between anal intercourse and acquisition of either infection. However, insertive, not receptive, anal intercourse was the major risk factor identified for HBV seroconversion, suggesting that transurethral exposure is an important mode of transmission. These data suggest that HBV is transmitted 8.6-fold more efficiently than HIV-1 among homosexual men studied and underscore the benefits of both HBV immunization and use of condoms during intercourse to prevent HBV infection.
Asunto(s)
Seropositividad para VIH/transmisión , Hepatitis B/transmisión , Homosexualidad , Enfermedades Virales de Transmisión Sexual , Estudios de Cohortes , Seropositividad para VIH/epidemiología , Seroprevalencia de VIH , VIH-1 , Hepatitis B/epidemiología , Hepatitis B/etiología , Humanos , Estudios Longitudinales , Masculino , Prevalencia , Estudios Prospectivos , Conducta Sexual , Enfermedades Virales de Transmisión Sexual/epidemiologíaRESUMEN
In the course of learning their HIV serostatus, gay and bisexual men participated in small discussion groups aimed at increasing their practice of safer sex. Small discussion groups were randomly assigned to receive one of two interventions: a lecture/discussion by a gay health educator, or an intervention that included the lecture/discussion followed by a small group process aimed at increasing social skills for safer sex and at increasing peer support for safer sex. Men completed questionnaires relating to their knowledge about HIV and AIDS, attitudes toward sexual behavior change, and self-reported sexual behavior. At second follow-up, one year post-intervention, men who had received skills training and peer support endorsed significantly stronger attitudes in favor of safer sex than did men receiving lecture/discussion only. In particular, skills training and peer support caused greater reduction of the value placed on ejaculation inside the partner, stronger endorsement of plans to use condoms, and greater reduction of negative attitudes about condoms, than did lecture/discussion only. These results are helpful to design interventions for men who continue to engage in riskful behavior.
Asunto(s)
Bisexualidad , Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Homosexualidad , Conducta Sexual , Adolescente , Adulto , Anciano , Análisis de Varianza , Homosexualidad/psicología , Humanos , Masculino , Persona de Mediana Edad , Grupo Paritario , Análisis de Regresión , Factores de Riesgo , Apoyo Social , Encuestas y CuestionariosRESUMEN
Thirteen homosexual men, volunteers in a study of the natural history of HIV, who seroconverted to HIV after participating in an educational program on HIV prevention, were interviewed about the circumstances leading to their seroconversion. Six men had participated in unprotected anal intercourse with at least one partner whom they believed was HIV-negative. Four men attributed their conversion to mental health problems or to drug and alcohol use. Two men's seroconversions could not be ascertained and one man attributed seroconversion to a condom break. Most men who had learned how to avoid infection, and had successfully done so for a time, had knowingly engaged in unsafe behaviors because of strong emotional responses to certain partners or because of mental health or drug and alcohol-related problems. Skills training for dealing with partners who pressure men to behave unsafely is needed, as is mental health and drug and alcohol counseling for men at risk for HIV infection.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/prevención & control , Bisexualidad , Seropositividad para VIH/psicología , Educación en Salud , Homosexualidad , Conducta Sexual , Adulto , Actitud Frente a la Salud , Conducta de Elección , Dispositivos Anticonceptivos Masculinos , Emociones , Falla de Equipo , Seropositividad para VIH/transmisión , Humanos , Conducta Impulsiva , Masculino , Persona de Mediana Edad , Factores de Riesgo , Seguridad , Parejas Sexuales/psicología , Trastornos Relacionados con Sustancias/complicacionesRESUMEN
We investigated the association between human immunodeficiency virus (HIV) and Epstein-Barr virus (EBV) infections in 593 homosexual men. The status of EBV infection in this group was evaluated based on serological evidence of EBV-specific antibody responses. The geometric mean titers (GMT) of antibody to EBV capsid antigen (EBV-VCA) (1:154) and EBV early antigen (EA) (1:16) in 141 HIV-seropositive men were significantly higher than respective titers in 452 HIV seronegative men (1:95 and 1:12). Antibody titers to EBV were higher in HIV-infected men with lymphadenopathy than in asymptomatic HIV-seropositive men. However, these correlation were less evident in patients with AIDS-related complex. Elevated antibody titers to EBV were found to be independent of levels of total serum IgG. Cytomegalovirus (CMV) antibody titers were also found to be significantly increased among HIV-seropositive men, independent of total IgG. Antibody titers to EBV were not correlated with those to CMV in either HIV-seronegative or HIV-seropositive men. Subjects without evidence of HIV infection, but who had high antibody titers to EBV-VCA and EBV-EA, had elevated mean numbers of CD3+, CD4+, and CD8+ cells, and lower levels of CD4+/CD8+ cell ratios compared to subjects with low EBV-antibody titers. This study suggests that the elevated levels of circulating antibodies against EBV in homosexual men are associated with loss of control of latent EBV due to HIV infection.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/microbiología , Anticuerpos Antivirales/análisis , Herpesvirus Humano 4/inmunología , Homosexualidad , Síndrome de Inmunodeficiencia Adquirida/inmunología , Síndrome de Inmunodeficiencia Adquirida/patología , Citomegalovirus/inmunología , Seropositividad para VIH/inmunología , Seropositividad para VIH/microbiología , Seropositividad para VIH/patología , Humanos , Recuento de Leucocitos , Linfocitos T/clasificaciónRESUMEN
This study evaluates two AIDS risk-reduction interventions targeted at homosexual and bisexual men. Participants were randomized into two peer-led interventions: both involved a lecture on 'safer sex', and one provided a skills-training component during which men could discuss and rehearse the negotiation of safer sexual encounters. Follow-up data collection assessed self-reported changes in sexual behavior at 6 and 12 months. Skills training increased condom use for insertive anal intercourse. In sessions providing skills training, condom use increased, on average, by 44% between pre-test and second follow-up compared with only 11% on average in sessions which did not provide such training.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/prevención & control , Bisexualidad , Homosexualidad , Educación del Paciente como Asunto , Conducta Sexual , Adulto , Anciano , Análisis de Varianza , Estudios de Cohortes , Dispositivos Anticonceptivos Masculinos , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Distribución Aleatoria , Factores de RiesgoRESUMEN
The T-cell colony assay is a highly sensitive measure of immunological dysfunction. The present study evaluated this in vitro response in asymptomatic HIV-infected homosexuals, those with chronic adenopathy as their only clinical manifestation and patients with either ARC or AIDS. The mean colony count in antibody-positive asymptomatic individuals was significantly reduced when compared to either heterosexual controls or antibody-negative homosexuals. Furthermore, there were no differences in the responses of these antibody-positive individuals and those with chronic lymphadenopathy as their only clinical manifestation. By contrast, patients with AIDS or ARC showed a profound defect; this suggests that the colony assay can detect a functional gradient across the spectrum of HIV infections. Colony growth was correlated with the absolute number of T-helper cells and the ability of PHA-stimulated lymphocytes to express IL-2 receptors; no correlation was found with the number of suppressor/cytotoxic cells or in vitro production of IL-2. Recent HIV seroconverters had normal colony counts but impaired ability to express IL-2 receptors. These data suggest a sequential loss of T-cell function as a result of HIV infection; the earliest manifestations are impaired expression of IL-2 receptors and reduced proliferative responses, as measured in the colony assay.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/inmunología , Receptores de Antígenos de Linfocitos T/biosíntesis , Receptores Inmunológicos/biosíntesis , Linfocitos T/inmunología , Complejo Relacionado con el SIDA/inmunología , Células Clonales/efectos de los fármacos , Humanos , Interleucina-2/biosíntesis , Recuento de Leucocitos , Masculino , Fitohemaglutininas/farmacología , Receptores de Interleucina-2 , Linfocitos T Colaboradores-Inductores/inmunología , Linfocitos T Reguladores/inmunologíaRESUMEN
Beginning in the latter part of 1985, 2,047 gay and bisexual men who were enrolled in the Pitt Men's Study, the Pittsburgh cohort of the Multicenter AIDS Cohort Study (MACS), were invited by mail to learn the results of their antibody test for HIV infection--human immunodeficiency virus infection. Participants were asked to complete and return a questionnaire designed to assess the factors influencing their (a) decision about learning the results, (b) recent sexual behavior, (c) knowledge about acquired immunodeficiency syndrome (AIDS), and (d) attitudes toward AIDS risk reduction. Of those men, 1,251 (61 percent) accepted the invitation, 188 (9 percent) declined, and 608 (30 percent) failed to respond. Fifty-four percent of the cohort subsequently learned their results. There were no significant differences in demographic, behavioral, and attitudinal characteristics or HIV seroprevalence between the men who accepted and those who declined. However, significant demographic differences were noted between the men who responded to the invitation versus those who did not; the latter group was composed of a greater proportion of men who were younger, nonwhite, and less educated. The most frequently cited reason (90 percent) why men wanted their test results was to determine if they had been infected with HIV. Of those who declined, 30 percent cited concerns about the psychological impact of learning about a positive result as being the most important factor for their decision. The two most frequently selected reasons for declining were the belief that the test is not predictive of the development of AIDS (48 percent) and concern about the worry that a positive result would produce (48 percent). These findings are discussed in the context of a nationwide, voluntary HIV screening program for gay and bisexual men.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/psicología , Anticuerpos Antivirales/análisis , Cognición , VIH/inmunología , Síndrome de Inmunodeficiencia Adquirida/inmunología , Adulto , Actitud Frente a la Salud , Anticuerpos Anti-VIH , Homosexualidad , Humanos , Masculino , Grupos Minoritarios , Estudios Prospectivos , Conducta Sexual , Encuestas y Cuestionarios , Programas VoluntariosRESUMEN
We conducted a study to assess the effect of human immunodeficiency virus (HIV) infection on humoral immunity. Fifty-five homosexual men and 19 heterosexual men had four- to six-week postimmunization antibody responses measured to trivalent influenza vaccine and 23-valent pneumococcal vaccine. The homosexual men were divided into three groups: 20 asymptomatic HIV-seronegative men, 10 asymptomatic HIV-seropositive men, and 25 HIV-seropositive men with persistent generalized lymphadenopathy. Antibody responses to influenza antigens in the subgroups of homosexual men did not significantly differ from those of heterosexual controls. The IgG antibody responses to pneumococcal capsular types 9N and 18C in men with lymphadenopathy, and type 18C in HIV-seronegative homosexual men, were lower than those of heterosexual controls. Otherwise, responses to other ten capsular types showed no significant differences. There was no evidence of an immunosuppressive effect of vaccination on T-cell numbers, or deterioration of clinical status associated with vaccination. This study demonstrates that HIV-infected homosexual men, asymptomatic or with persistent generalized lymphadenopathy, are able to mount appropriate antibody responses to two commonly used vaccines.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/inmunología , Anticuerpos Antibacterianos/biosíntesis , Anticuerpos Antivirales/biosíntesis , Vacunas Bacterianas/inmunología , Vacunas contra la Influenza/inmunología , Adulto , Pruebas de Inhibición de Hemaglutinación , Homosexualidad , Humanos , Inmunoglobulina G/biosíntesis , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Vacunas NeumococicasRESUMEN
As a result of the AIDS (Acquired Immune Deficiency Syndrome) epidemic, many community health agencies are faced with the task of planning and implementing programs to prevent or reduce the risks of HIV (Human Immunodeficiency Virus) infection. Furthermore, the urgency of AIDS will force community groups to develop prevention programs prior to an analysis of substantial data relating to intervention efficacy. By using the five criteria for the development of health promotion and education programs enumerated by the American Public Health Association, planners can benefit from the experience of past health promotion initiatives, and insure a comprehensive approach to planning. The authors describe, using specific examples, how these criteria were used to develop and implement an AIDS risk reduction program for gay and bisexual men.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/prevención & control , Educación en Salud , Promoción de la Salud/métodos , Homosexualidad , Síndrome de Inmunodeficiencia Adquirida/etiología , Objetivos , Humanos , Masculino , Factores de RiesgoRESUMEN
Homosexual men were studied for associations among human T-lymphotropic virus type III (HTLV-III) infection, Epstein-Barr virus (EBV) infection, and T cell abnormalities. The presence of IgG antibody to EBV capsid antigen and antibody to EBV early antigen was significantly associated with augmented counts of suppressor T cells in healthy HTLV-III-seronegative men. HTLV-III-seropositive asymptomatic subjects had significantly enhanced titers of antibody to EBV and lower ratios of helper to suppressor T cells compared with HTLV-III-seronegative homosexual men. Of three men who seroconverted to HTLV-III, two had a greater than fourfold increase in titer of IgG antibody to EBV capsid antigen after seroconversion. These results suggest that the interaction of HTLV-III and EBV and their immunologic perturbations are significant in the natural history of this retrovirus infection in homosexual men.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Proteínas de la Cápside , Infecciones por Herpesviridae/complicaciones , Infecciones por Retroviridae/complicaciones , Linfocitos T Colaboradores-Inductores , Linfocitos T Reguladores , Síndrome de Inmunodeficiencia Adquirida/sangre , Síndrome de Inmunodeficiencia Adquirida/inmunología , Adolescente , Adulto , Anticuerpos Antivirales/análisis , Antígenos Virales/inmunología , Deltaretrovirus/inmunología , Anticuerpos Anti-VIH , Infecciones por Herpesviridae/sangre , Infecciones por Herpesviridae/inmunología , Herpesvirus Humano 4 , Homosexualidad , Humanos , Inmunoglobulina G/análisis , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Infecciones por Retroviridae/sangre , Infecciones por Retroviridae/inmunologíaRESUMEN
We studied 56 asymptomatic homosexual male volunteers in Pittsburgh for 1 1/2 yr for relationships between cytomegalovirus (CMV) and human T-lymphotropic virus type III (HTLV-III) infections. CMV was most frequently isolated from semen (8%) as compared with throat washings (5.9%) and urine (0%) on initial testing of CMV-seropositive subjects. Other viruses commonly isolated from immunosuppressed patients (herpes simplex virus, adenovirus) were rarely detected in this cohort. Seropositivity to HTLV-III was significantly associated with isolation of CMV from semen in our asymptomatic cohort (odds ratio = 9.5, p = .008). These results suggest that HTLV-III infection is associated with selective, temporal activation of CMV in the genital tract of asymptomatic homosexual men.
Asunto(s)
Anticuerpos Antivirales/análisis , Citomegalovirus/aislamiento & purificación , VIH/inmunología , Semen/microbiología , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Adolescente , Adulto , Infecciones por Citomegalovirus/complicaciones , Anticuerpos Anti-VIH , Homosexualidad , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Recruiting gay and bisexual men into AIDS-related research and education programs will become increasingly common as federal, state and local funds become available. The Pitt Men's Study, a study of the natural history of Human Immunodeficiency Virus (HIV) infection, developed a recruitment strategy based on marketing principles. These techniques allowed the study to target particular gay and bisexual groups for inclusion. 1718 gay and bisexual men were recruited. Non-whites and unemployed men were targeted and recruited in numbers comparable to their representation in the larger community.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/prevención & control , Aceptación de la Atención de Salud , Adulto , Publicidad/métodos , Etnicidad , Homosexualidad , Humanos , Masculino , Pennsylvania , Proyectos de InvestigaciónRESUMEN
Previously defined "risk factors" in homosexuals with Kaposi's sarcoma may not be causative of AIDS (acquired immune deficiency syndrome) but are an important tool in identifying segments of the homosexual population who are at increased risk for the development of AIDS and who may benefit from health education and surveillance efforts. The epidemiologic characteristics of such a group of homosexuals from a low incidence area (Pittsburgh, PA) are examined and several factors which may account for differences in incidence are briefly discussed.