Cohort Of Homosexual Men Research Articles

Unexpectedly higher levels of anti-orthopoxvirus neutralizing antibodies are observed among gay men than general adult population

BackgroundThe confirmed cases in the current outbreak of Monkeypox are predominantly identified in the networks of men who have sex with men (MSM). The preexisting antibodies may profoundly impact the transmission of monkeypox virus (MPXV), however the current-day prevalence of antibodies against MPXV among gay men is not well characterized.MethodsA cohort of gay men (n = 326) and a cohort of the general adult population (n = 295) were enrolled in this study. Binding antibodies responses against MPXV/vaccinia and neutralizing antibody responses against vaccinia virus (Tiantan strain) were measured. The antibody responses of these two cohorts were then compared, as well as the responses of individuals born before and in/after 1981 (when the smallpox vaccination ceased in China). Finally, the correlation between the anti-MPXV antibody responses and the anti-vaccinia antibody responses, and the associations between preexisting anti-orthopoxvirus antibody responses and the diagnosed sexually transmitted infections (STIs) in the MSM cohort were analyzed separately.ResultsOur data showed that binding antibodies against MPXV H3, A29, A35, E8, B6, M1 proteins and vaccinia whole-virus lysate could be detected in individuals born both before and in/after 1981, of which the prevalence of anti-vaccinia binding antibodies was significantly higher among individuals born before 1981 in the general population cohort. Moreover, we unexpectedly found that the positive rates of binding antibody responses against MPXV H3, A29, A35, E8 and M1 proteins were significantly lower among individuals of the MSM cohort born in/after 1981, but the positive rates of anti-MPXV B6 and anti-vaccinia neutralizing antibody responses were significantly higher among these individuals compared to those of age-matched participants in the general population cohort. Additionally, we demonstrated that the positive and negative rates of anti-MPXV antibody responses were associated with the anti-vaccinia antibody responses among individuals born before 1981 in the general population cohort, but no significant association was observed among individuals born in/after 1981 in both cohorts. The positive rates of both the binding and the neutralizing antibody responses were comparable between individuals with and without diagnosed STIs in the MSM cohort.ConclusionsAnti-MPXV and anti-vaccinia antibodies could be readily detected in an MSM cohort and a general population cohort. And a higher level of anti-vaccinia neutralizing antibody responses was observed among individuals who did not get vaccinated against smallpox in the MSM cohort compared to age-matched individuals in the general population cohort.

Prevalence and risk factors associated with high-grade anal squamous intraepithelial lesions (HSIL)-AIN2 and HSIL-AIN3 in homosexual men

BackgroundAnal intraepithelial neoplasia grade 2 (AIN2) and AIN grade 3 (AIN3) are commonly grouped together as high grade squamous intraepithelial lesions (HSIL). We assessed risk factors for HSIL-AIN2 and HSIL-AIN3 in a cohort of homosexual men. MethodsAt the baseline visit in the Study for the Prevention of Anal Cancer (SPANC), all men completed a questionnaire and underwent anal swabbing for cytology and HPV genotyping, followed by high resolution anoscopy. ResultsComposite-HSIL prevalence was 47% and 32% among 220 HIV-positive and 396 HIV-negative men, respectively. HSIL-AIN3 (37.7% versus 24.7%; p<0.001), but not HSIL-AIN2 (9.5% versus 7.6%; p=0.395) was more common in HIV-positive men. Recent receptive anal partners (p-trend=0.045), and increasing number of high-risk (HR)-HPV types (p-trend<0.001) were associated with HSIL-AIN2. Lifetime receptive partners (p-trend<0.001), HIV status (OR 1.74; 95% CI: 1.05–2.87) and HPV16 (OR 3.00; 95% CI: 1.56–5.75) were associated with HSIL-AIN3. HPV16 was the most common HR-HPV type detected in men with HSIL-AIN3, both HIV-negative (61.1%) and HIV-positive (54.9%). HPV16 was less commonly detected in men with HSIL-AIN2. ConclusionsGrouping HSIL-AIN2 and HSIL-AIN3 as HSIL may mask considerable heterogeneity in anal cancer risk. Given the strong link between HPV16 and anal cancer, men with HSIL-AIN3 and HPV16 are likely to be at greatest risk of cancer.

The performance of anal cytology as a screening test for anal HSILs in homosexual men.

Studies regarding the performance of anal cytology in which both the screening test (cytology) and the diagnostic test (high-resolution anoscopy [HRA]) are performed in all members of a screening population are rare. The authors evaluated the performance of liquid-based anal cytology in a cohort of homosexual men in Sydney, New South Wales, Australia. The Study of the Prevention of Anal Cancer (SPANC) is a 3-year prospective study of the natural history of anal human papillomavirus infection in homosexual men aged ≥35 years. At baseline, all participants underwent a liquid-based anal cytology test and HRA at the same clinical visit. Biopsies were obtained for histological assessment if lesions suspicious for human papillomavirus infection were visible during HRA. Using any cytological abnormality as the threshold, the sensitivity, specificity, and positive and negative predictive values were calculated against histologically diagnosed high-grade squamous intraepithelial lesions (HSILs). Among 617 men recruited, the median age was 49 years (range, 35-79 years) and 35.7% were positive for the human immunodeficiency virus. Overall, the sensitivity of cytology was 83.2%, the specificity was 52.6%, the positive predictive value was 45.8%, and the negative predictive value was 86.7%. Specificity improved with increasing age (P for trend =.041). Sensitivity was significantly higher in men with >1 anal octant of biopsy-confirmed HSIL (92.9% vs 77.7%; P = .010), and in those who had ≥10 metaplastic cells present on their cytology slides (87.5% vs 70.2%; P = .007). Anal cytology was found to have a higher specificity in older men while maintaining sensitivity. Sensitivity was higher among those with more extensive HSILs and men with metaplastic cells present on cytology. Cancer Cytopathol 2016;124:415-24. © 2016 American Cancer Society.

P10.13 Prevalence and predictors of high-risk anal human papillomavirus (hpv) types in the study of the prevention of anal cancer (spanc)

Introduction HPV causes ~90% of anal cancers, with HPV16 predominating. Gay men, particularly HIV-positive men, are at greatly increased risk of anal cancer. We describe prevalence and predictors of anal canal detection of any HPV, high-risk (hr) HPV and HPV16, in a cohort of Australian gay men. Methods SPANC is a 3-year community-recruited, prospective study of HIV(+) and HIV(-) gay men aged ≥35 years. At 6-monthly visits participants complete questionnaires, undergo high resolution anoscopy and anal swabs for cytology and HPV genotyping (Roche Linear Array). Results By December 2014, 482 participants (median age 49.5 years; 31% HIV positive) had attended a baseline visit. The majority (87%) had ≥1 HPV genotype detected, with ~ two thirds (65%) having ≥1 hrHPV detected. HPV16 was detected in 31% of participants. HIV positive participants and younger participants were more likely to have any HPV detected (p = 0.001 and p = 0.033 respectively). The detection of hrHPV in univariate analyses was significantly associated with positive HIV status (p = 0.001), currently smoking (p = 0.014), younger age (p = 0.012), more lifetime male sexual partners (p = 0.003), more lifetime receptive (RAI) and insertive (IAI) anal intercourse (p = 0.037 and p = 0.002 respectively) history of anal chlamydia (p = 0.003), more receptive anal behaviours in the last 6 months, including RAI (p HPV16 detection among HIV positive participants was four times more likely among men with a last CD4 cell count Conclusion Anal HPV was extremely common in this cohort of homosexual men. Prevalent HPV16 was related to low CD4 count in HIV positive men. Receptive anal sexual practices, including rimming and fingering were predictors of hrHPV detection. Disclosure of interest statement AEG has received honoraria and research funding from CSL Biotherapies, honoraria and travel funding from Merck, and sits on the Australian advisory board for the Gardasil HPV vaccine. CKF has received honoraria, travel funding and research funding from CSL and Merck, sits on the Australian advisory board for the Gardasil HPV vaccine, and owns shares in CSL Biotherapies. SMG has had grant support from CSL Bio and GlaxoSmithKline, and lecture fees from Merck, GlaxoSmithKline and Sanofi Pasteur; in addition, has received funding through her institution to conduct HPV vaccine studies for MSD and GlaxoSmithKline and is a member of the Merck Global Advisory Board as well as the Merck Scientific Advisory Committee for HPV. RJH has received support from CSL Biotherapies and MSD. All other authors declare that they have no conflicts of interest.

Stories from two generations of gay men living in the midst of HIV-AIDS

In Australia and other Western countries, gay men and intravenous drug users were particularly vulnerable to moral judgement and stigma in the early years of the HIV-AIDS epidemic. For most of the final decades of the twentieth century, HIV-AIDS policy and debate in Australia focussed on the initial cohort of gay men who were affected—that is, those born in the late 1940s and 1950s. Since the early 2000s, however, increased rates of HIV infection have shifted focus to men born in more recent decades, the 1980s and 1990s in particular, during which sustained, publicly funded health messages were commonplace. Our analysis of interviews with 56 gay Australian men who were HIV-negative at the time of interview focused on the effect of HIV-AIDS on the participants' sense of self and revealed evidence of three principal narratives: self-regard, sexual self, and self and others. While we found variations within and between the cohorts, our research showed that HIV-AIDS has had a similar impact on the identities and lived experiences of both generations of Australian gay men.

Parasitic Infections in Solid Organ Transplantation

Parasitic Infections in Solid Organ Transplantation

Serum neutralizing activities from a Beijing homosexual male cohort infected with different subtypes of HIV-1 in China.

Protective antibodies play a critical role in an effective HIV vaccine; however, eliciting antibodies to block infection by viruses from diverse genetic subtypes remains a major challenge. As the world’s most populous country, China has been under the threat of at least three major subtypes of circulating HIV-1 viruses. Understanding the cross reactivity and specificities of serum antibody responses that mediate broad neutralization of the virus in HIV-1 infected Chinese patients will provide valuable information for the design of vaccines to prevent HIV-1 transmission in China. Sera from a cohort of homosexual men, who have been managed by a major HIV clinical center in Beijing, China, were analyzed for cross-sectional neutralizing activities against pseudotyped viruses expressing Env antigens of the major subtype viruses (AE, BC and B subtypes) circulating in China. Neutralizing activities in infected patients’ blood were most capable of neutralizing viruses in the homologous subtype; however, a subset of blood samples was able to achieve broad neutralizing activities across different subtypes. Such cross neutralizing activity took 1–2 years to develop and CD4 binding site antibodies were critical components in these blood samples. Our study confirmed the presence of broadly neutralizing sera in China’s HIV-1 patient population. Understanding the specificity and breadth of these neutralizing activities can guide efforts for the development of HIV vaccines against major HIV-1 viruses in China.

The voice of others: Identity, alterity and gender normativity among gay men in Israel

AbstractThis article presents an analysis of a slang variety, calledoxtšit, as it is described and used by a cohort of gay men in Israel. Unlike many previous analyses of gay slang, I argue that the men described do not use the variety to help construct and affirm an alternative gay identity, but rather that they use it as a form of in-group mockery through which normative and nonnormative articulations of Israeli gay male sexuality are delineated. It is suggested that this discussion has implications for sociolinguistic understandings of “groupness” more broadly, and particularly the relationship between macro-level social categories (like “gay”) and individual lived experience. (Gay slang, Israel, vari-directional voicing, identity/alterity)*

Absence of HIV‐1 Superinfection 1 Year after Infection between 1985 and 1997 Coincides with a Reduction in Sexual Risk Behavior in the Seroincident Amsterdam Cohort of Homosexual Men

Incidence rates of human immunodeficiency virus type 1 (HIV-1) superinfection differ among cohorts and, as yet, only 2 cohorts of homosexual men have been screened. Here, we investigated the incidence of HIV-1 superinfection during the first year after infection among homosexual participants in the Amsterdam Cohort Studies on HIV infection and AIDS who seroconverted between 1985 and 1997. We analyzed env C2-C4 diversity in the serum of therapy-naive participants, using a heteroduplex mobility assay; heteroduplexes were considered to be indicators of potential dual infections, in which case env C2-C4 polymerase chain reaction (PCR) products were cloned and sequenced. Sequences were subjected to phylogenetic analysis. Data on the sexual behavior of participants were collected from 1 year before seroconversion until the end of the investigated period. For 89 seroconverters with a detectable viral load (>1000 copies/mL), env PCR products were generated from serum samples obtained at seroconversion and 1 year later. Heteroduplexes were observed in 68 of the 89 patients; among these 68 patients, a median of 9 molecular clones per time point was sequenced. Phylogenetic analysis did not reveal evidence for superinfection; 1 patient was HIV-1 coinfected. Shortly after diagnosis of HIV infection, the number of sex partners decreased, the frequency of anal intercourse declined, and condom use increased. The incidence of HIV-1 superinfection soon after seroconversion in this cohort is low. Risk reduction shortly after HIV-1 diagnosis early during the HIV-1 epidemic in the Netherlands may have contributed to the absence of HIV-1 superinfection observed in this study.

Unprotected anal intercourse, risk reduction behaviours, and subsequent HIV infection in a cohort of homosexual men

A range of risk reduction behaviours in which homosexual men practise unprotected anal intercourse (UAI) has been described. We aimed to assess the extent of any reduction in HIV risk associated with these behaviours. A prospective cohort study of HIV-negative homosexual men in Sydney, Australia. Men were followed up with 6-monthly detailed behavioural interviews and annual testing for HIV. The four risk reduction behaviours (behaviourally defined) examined were serosorting, negotiated safety, strategic positioning, and withdrawal during receptive UAI (UAI-R). In 88% of follow-up periods in which UAI was reported, it occurred in the context of consistent risk reduction behaviours. Compared with those who reported no UAI, the risk of HIV infection was not raised in negotiated safety [hazard ratio = 1.67, 95% confidence interval (CI) 0.59-4.76] and strategic positioning (hazard ratio = 1.54, 95% CI 0.45-5.26). Serosorting outside negotiated safety was associated with an intermediate rate of HIV infection (hazard ratio = 3.11, 95% CI 1.09-8.88). Withdrawal was associated with a higher risk than no UAI (hazard ratio = 5.00, 95% CI 1.94-12.92). Patterns of UAI differed greatly according to partner's serostatus. Men who reported serosorting were less likely to report either strategic positioning or withdrawal. Each behaviour examined was associated with an intermediate HIV incidence between the lowest and highest risk sexual behaviours. The inverse association between individual behaviours suggests that men who practise serosorting rely on this protection. The high prevalence of these behaviours demands that researchers address the contexts and risks associated with specific types of UAI.

Prevalence, incidence and risk factors for pharyngeal chlamydia in the community based Health in Men (HIM) cohort of homosexual men in Sydney, Australia

To determine the prevalence, incidence and risk factors for pharyngeal Chlamydia trachomatis in the community based Health in Men (HIM) cohort of HIV negative homosexual men in Sydney, Australia. From January 2003, all HIM participants were offered annual screening for pharyngeal chlamydia using BD ProbeTec nucleic acid amplification testing (NAAT). Detailed sexual behavioural data were collected every 6 months, and risk factors for infection and hazard ratios were calculated using Cox regression. Among 1427 participants enrolled, the prevalence of pharyngeal chlamydia on initial testing was 1.06% and the incidence rate was 0.58 per 100 person-years. More than 50% of all infections were identified on baseline testing and 68% of men with pharyngeal infection had no evidence of concurrent anogenital chlamydia. There was no association of pharyngeal chlamydia with sore throat. Infection was significantly associated with increasing frequency of receptive penile-oral sex with ejaculation with casual partners (p = 0.009), although approximately half of infections occurred in participants not reporting this risk behaviour. Neither kissing nor oro-anal practices were associated with infection. The incidence of pharyngeal chlamydia infection in the HIM study was relatively low; however, the relatively high prevalence on baseline testing compared to incidence suggests a long duration of infection. Occasional screening for pharyngeal chlamydia in homosexual men who frequently practise receptive oral sex with ejaculation may be warranted.

Trend in HIV incidence in a cohort of homosexual men in Sydney: data from the Health in Men Study

To determine the incidence of HIV seroconversion in a community-based cohort of homosexual men in Sydney from 2002 to 2006. Participants were recruited between 2001 and 2004 from community-based events and venues. They were tested for HIV annually at follow-up interviews. Each year, the study database was matched against the national HIV register to identify additional HIV seroconversions among men lost to active follow up. The trend in HIV incidence over time was examined using Cox regression. Among 1426 participants, 52 cases of HIV seroconversion were identified between 2002 and 2006, an incidence of 0.87 per 100 person-years (95% CI: 0.65-1.14). HIV incidence varied from 1.67 per 100 person-years in 2002 to 0.39 in 2006 (P trend = 0.282). The median age of HIV seroconversion was 36.9 years, ranging from 22 to 63 years. In this community-based cohort of highly sexually active homosexual men in Sydney, HIV incidence was close to 1% each year and declined non-significantly between 2002 and 2006. These data are consistent with surveillance data suggesting no increase in recent HIV incidence in homosexual men in New South Wales.

65. CIRCUMCISION STATUS AND RISK OF SEXUALLY TRANSMITTED INFECTIONS IN THE HIM COHORT OF HOMOSEXUAL MEN IN SYDNEY, AUSTRALIA

Objectives: To examine circumcision status as an independent risk factor for prevalent and incident sexually transmitted infections (STIs) in the community-based Health in Men (HIM) cohort of homosexual men. Methods: Between 2001 and 2004, 1427 initially HIV-negative men were enrolled. Circumcision status was self-reported at baseline and was validated by clinical examination in a sub-sample of participants. All participants were tested annually for HIV and offered testing for other STIs including nucleic acid amplification tests (NAAT) for urethral gonorrhoea and chlamydia, and serology for syphilis and herpes simplex virus (HSV). Demographic information and past history of STIs was collected at baseline and detailed information on sexual risk behaviours was collected every 6 months. At annual face-to-face visits, participants reported diagnoses of STIs made in the previous 12 months. Results: At baseline, 66% of participants reported being circumcised; mostly as infants. Uptake of STI testing was high with over 90% of participants tested each year. On multivariate analysis, controlling for age and sexual risk behaviour, circumcision was not associated with baseline seropositivity to syphilis (p�=�0.34), HSV1 (p�=�0.33) or HSV2 (p�=�0.92), nor with a history of self-reported genital warts (p�=�0.18). There was also no association with incident bacterial urethral infections (p�=�0.67 &amp; p�=�0.89 for gonorrhoea and chlamydia, respectively), self-reported incident genital warts (p�=�0.35), incident HSV1 (p�=�0.70) or incident HSV2 (p�=�0.36). However, circumcision was associated with a significantly reduced risk of incident syphilis after controlling for age, number of casual partners in the previous 6 months and unprotected anal intercourse according to partners' HIV status (HR�=�0.35, 95% CI 0.14-0.87, p�=�0.024). Conclusion: Circumcised men had a reduced risk of incident syphilis in this cohort. Although most STIs were not associated with circumcision, these data suggest that circumcision may have an effect on syphilis acquisition in homosexual men.

41. CIRCUMCISION AND RISK OF HIV SEROCONVERSION IN THE HIM COHORT OF HOMOSEXUAL MEN IN SYDNEY

Objectives: We examined circumcision as a risk factor for HIV seroconversion in a community-based cohort of homosexual men in Sydney. Methods: Between 2001 and 2004, 1427 initially HIV-negative men were enrolled. Circumcision status was self-reported at baseline, and self-report was validated by clinical examination during study visits in a sub-sample of approximately 300 participants. All participants were tested annually for HIV and offered testing for other sexually transmitted infections (STIs). Detailed information on sexual risk behaviours was collected every 6 months. Results: At baseline, 66% of participants reported being circumcised; mostly as infants. The proportion circumcised ranged from 83% in those aged 45 or more to only 50% in those aged less than 25 (p�&lt;�0.0001). There were 49 HIV seroconversions through 2006, an incidence of 0.80 per 100 person years (PY). Anorectal gonorrhoea and anal warts were independent risk factors for HIV infection. Overall, being circumcised was not related to HIV infection (relative risk (RR) 1.07, 95% CI 0.56-2.06). After controlling for non-concordant unprotected anal intercourse (UAI), anorectal STIs and age, there remained no association with circumcision (RR�=�0.88, 95% CI 0.45-1.74). Only nine of the 49 seroconversions occurred among men who reported no receptive UAI, an incidence of 0.35 per 100PY. In this group, circumcision was also not associated with HIV seroconversion (RR�=�0.99, 95% CI 0.25-3.96). Conclusion: Overall, circumcision status was not associated with HIV seroconversion. In addition, analyses limited to those men who reported no receptive UAI, who are more likely to have been infected through insertive sex, suggest that circumcision may not reduce HIV risk even for insertive anal intercourse. Other preventive strategies are required to reduce HIV incidence in homosexual men.

25. ANAL SEXUALLY TRANSMISSIBLE INFECTIONS AS RISK FACTORS FOR HIV SEROCONVERSION

Objectives: Sexually transmitted infections (STIs) are believed to increase the risk of HIV acquisition, but few studies have focused on homosexual men. We examined sexual behaviour and common STIs as independent risk factors for HIV seroconversion in a community-based cohort of homosexual men in Sydney. Methods: Between 2001 and 2004, 1427 initially HIV-negative men were enrolled. They were tested annually for HIV, for gonorrhoea and chlamydia in the urethra and anus (strand displacement amplification, BDProbeTec), and for herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) using type specific ELISA. Participants also reported diagnoses of STIs since their last interview. Detailed information on sexual risk behaviours was collected every 6 months. Results: There were 49 HIV seroconversions through 2006, an incidence of 0.80 per 100PY. A higher number of episodes of insertive and receptive unprotected anal intercourse (UAI) with HIV positive or HIV status unknown partners was each significantly associated with HIV seroconversion. In multivariate analysis of behavioural risk factors, HIV seroconversion was significantly associated with a higher number of episodes of receptive UAI with a partner of unknown HIV status (p trend &lt;0.001) or with a partner known to be HIV positive (p trend &lt;0.001). After controlling for these sexual behaviours, a study diagnosis of anal gonorrhoea remained strongly related to HIV seroconversion (RR�=�7.41, 95% CI 1.75-31.75). Most cases of anal gonorrhoea diagnosed were asymptomatic. In addition, there was an independent association with anal warts (RR�=�3.43, 95% CI 1.43-8.19), and prevalent HSV-1 infection was of borderline significance (RR�=�2.78, 95% CI 0.99-7.80). Conclusion: Certain anal STIs were associated with HIV seroconversion, even after adjustment for UAI. For some anal conditions, in particular gonorrhoea, infection was frequently asymptomatic. Screening for anal STIs should be investigated as a potential HIV prevention intervention.

Clinical spectrum and virologic characteristics of anal intraepithelial neoplasia in HIV infection

Anal intraepithelial neoplasia (AIN) represents a precursor lesion of invasive squamous cell carcinoma with a clear association to high-risk human papillomavirus (HPV) types. HIV infection is strongly associated with a higher prevalence of genital HPV infection, a higher incidence of AIN, and, consecutively, an increased risk for anal cancer. The aim of this study was to determine the clinical spectrum of AIN and lesional HPV colonization in a cohort of homosexual men who were HIV positive and had a history of receptive anal intercourse. In all, 103 men who were HIV-1 positive were screened by using clinical, proctologic, cytologic, histologic, and HPV DNA testing. Of all patients, 86% had anal HPV infection at their first visit. HPV-16 (53%), HPV-18 (27%), HPV-58 (22%), and HPV-83 (22%) were the most frequently found HPV types. AIN was diagnosed in 20 of the 103 patients (19.4%). High-risk HPV types were present in all AIN cases with up to 7 different high-risk and up to 5 different low-risk types per lesion. Histologically, 7 (35%), 7 (35%), and 6 (30%) of the patients had AIN grade I, II, or III, respectively. Four different types of clinical presentation could be distinguished in the 20 patients with AIN: bowenoid (1 case, 5%); erythroplakic (2 cases, 10%); verrucous (6 cases, 30%); and leukoplakic (11 cases, 55%). All verrucous lesions were graded as high-grade intraepithelial lesions in cytology, whereas 6 of the 11 leukoplakic lesions (55%) were low grade. All verrucous AIN carried at least 4 different HPV types, always including HPV-16, and the mean number of HPV types was higher in verrucous lesions than in leukoplakic lesions (5.5 vs 3.8, respectively). These data confirm the high incidence and prevalence of AIN in patients who are HPV positive with HIV infection. Four different clinical types of AIN can be distinguished that might have prognostic implications. Standardized screening programs for anal cancer prevention and treatment protocols for AIN in patients infected with HIV must be implemented.

Hepatitis A and B infection and vaccination in a cohort of homosexual men in Sydney

To determine the prevalence and incidence of hepatitis A (HAV) and B (HBV) infection and vaccination in HIV-negative homosexual men in Sydney, and associated risk factors. An open prospective cohort study was conducted among a community-based sample of HIV-negative homosexual men in Sydney in 2001-02. Participants underwent a face-to-face interview, regarding demographics, sexual behavioural risk factors and sexually transmitted infections, and blood samples were collected. They were followed annually. Nine hundred and three men completed a baseline interview by the end of 2002. Among them, 68% were seropositive to hepatitis A. The seroprevalence of prior hepatitis B infection was 19%, and 53% had serological evidence of HBV vaccination. Younger men were much more likely to be seronegative, with 48% and 46% of <25-year-olds being seronegative to HAV and HBV respectively. In multivariate analysis HAV and HBV infection were associated with increasing age, greater number of lifetime sex partners and HBV infection was also associated with previous sexually transmitted infections. HAV vaccination was associated with increasing age, greater number of lifetime sex partners, overseas travel in the last year and self-reported anogenital warts. HBV vaccination was associated with higher occupational status, greater lifetime number of sex partners and previous sexually transmitted infections. Substantial proportions of gay community-attached young homosexual men are still at risk of HAV and HBV infection. This study points to a need for vaccination strategies which ensure high levels of hepatitis A and B immunity in young sexually active gay men.

“New Beginnings”: A Case Study in Gay Men's Changing Perceptions of Quality of Life during the Course of HIV Infection

This article reports results of an ethnographic study that sought to understand how a cohort of gay men living with HIV infection evaluated and worked to preserve or improve the quality of their lives. Themes of life story narratives are identified, each with an associated stylistic self-orientation to living with HIV infection. Changes in thematic content of a selected participant's life story narratives are discussed, demonstrating how events of his daily life are integrated into the narratives. Resultant concurrent shifting of themes and stylistic orientations is linked to his perception of improved quality of life.

Secular trends in the survival of HIV-infected homosexual men in Amsterdam and Vancouver estimated from a death-included CD4-staged Markov model

The purpose of this study was to investigate secular trends in waiting times in CD4-based stages of human immunodeficiency virus (HIV) disease progression in two cohorts of homosexual men, one in Vancouver and one in Amsterdam. All HIV-positive men with two or more CD4 counts in their AIDS-free period between 1 January 1985 and 1 January 1997 were included in this study. Data regarding clinical AIDS diagnoses (using the 1987 Centers for Disease Control and Prevention [CDC] AIDS case definition) and death were collected through active follow-up, review of hospital records, and municipal/national registries. The Vancouver Lymphadenopathy-AIDS Study (VLAS), was started in November 1982 and had enrollment until December 1984. Both HIV-negative and HIV-positive men were followed at intervals of 3-6 months until 1986 and annually thereafter. The Amsterdam cohort study on HIV and AIDS (ACS) started in December 1984, has ongoing enrollment and follow-up of both HIV-negative and HIV-positive homosexual men. The HIV-positive men were followed at intervals of 3 months. The CD4-based stage of an individual at each visit was determined using smoothed data. For each cohort and in each calendar time period, a CD4-based Markov model with death as the absorbing stage was fitted to the data. The parameters in this model were estimated using the method of maximum likelihood and confidence intervals were calculated using bootstrap methods. A total of 509 homosexual men participating in the VLAS were included in this study, providing 5356 visits. Some 292 men developed AIDS before 1 January 1997 and 239 died before this date. In all, 232 of the 239 deaths were AIDS related. Thirty-seven per cent of all visits were related to treatment. A total of 543 homosexual men participating in the ACS were included in this study, providing 10 043 visits; 277 men developed AIDS before 1 January 1997 and 250 died before this date. The date of AIDS diagnosis was known for 225 of the 250 deaths. Twenty per cent of all visits were related to treatment. We found that in both cohort studies the stage-specific waiting times were longer in the low CD4-based stages (stages 4, 5 and 6: i.e. CD4 count <500 cells per mm(3)) after March 1990 compared to waiting times before March 1990. The increase in mean waiting time in these stages with low CD4 count was 21%, 33% and 53%, respectively in the ACS and 20%, 2% and 29% in the VLAS. Because waiting times alone are not exclusive for progression in a reversible model we also calculated the stage-specific median incubation periods till death. Men spent considerably longer in these CD4-based stages after March 1990 compared to before March 1990. Data from these population-based cohort studies showed that HIV disease progression in the calendar period where treatment was administered was slower for individuals in stages with low CD4 counts. We found no evidence for shortening of the incubation period that may have appeared from increasing virulence of the HIV in the population.

Natural history of human immunodeficiency virus type 1 viremia after seroconversion and proximal to AIDS in a large cohort of homosexual men. Multicenter AIDS Cohort Study.

The natural history of human immunodeficiency virus type 1 (HIV-1) viremia and its association with clinical outcomes after seroconversion was characterized in a cohort of homosexual men. HIV-1 RNA was measured by reverse-transcription polymerase chain reaction (RT-PCR) in stored longitudinal plasma samples from 269 seroconverters. Subjects were generally antiretroviral drug naive for the first 3 years after seroconversion. The decline in CD4 lymphocyte counts was strongly associated with initial HIV RNA measurements. Both initial HIV RNA levels and slopes were associated with AIDS-free times. Median slopes were +0.18, +0.09, and -0.01 log10 copies/mL, respectively, for subjects developing AIDS <3, 3-7, and>7 years after seroconversion. In contrast, HIV RNA slopes in the 3 years preceding AIDS and HIV RNA levels at AIDS diagnosis showed little variation according to total AIDS-free time. HIV RNA load at the first HIV-seropositive visit ( approximately 3 months after seroconversion) was highly predictive of AIDS, and subsequent HIV RNA measurements showed even better prognostic discrimination.