Human Immunodeficiency Virus Seropositive Men Research Articles

High-resolution anoscopy for the diagnosis and treatment of human papillomavirus-related anal intraepithelial neoplasia in human immunodeficiency virus-seropositive men who have sex with men in Japan

High-resolution anoscopy for the diagnosis and treatment of human papillomavirus-related anal intraepithelial neoplasia in human immunodeficiency virus-seropositive men who have sex with men in Japan

Influence of male human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection on the reproductive outcomes in serodiscordant couples: a case-control study.

Nowadays, serodiscordant couples (SDCs) with human immunodeficiency virus (HIV) or hepatitis C virus (HCV)-infected men have the chance to conceive safely, giving birth with a minimum risk of cross-infection. To assess the impact of male HIV and HCV infection on the assisted reproductive technologies (ART) outcomes in SDCs, with HIV or HCV seropositive men and negative partners. Of 153 couples: 24 in Group 1 (HIV-seropositive men), 60 in Group 2 (HCV-seropositive men) and 69 in Group 3 (controls). Sperm-washing procedure was performed using a three-step system. Fresh ICSI cycles were carried out in HIV SDCs, HCV SDCs and controls. Seminal parameters, fertilization rate (FR), cleavage rate (CR), pregnancy rate per cycle (PR/C), miscarriage rate, implantation rate (IR) and live birth rate were evaluated. All the seropositive men have undetectable viral loads at the time of insemination, and both partners were free from co-morbid infections. The median number of embryos transferred was 2.0 (IQR 1.0-3.0), with no differences among groups. FR was significantly reduced in HIV and HCV SDCs compared to the controls (66%, 61% and 75%, respectively; p<0.01). CR was similar between groups (p=0.3). IR was 12.1%, 11.1% and 14.1%, respectively, in the three groups (p=0.30). PR/C was 21.7%, 17.6% and 20.2% in HIV, HCV and controls, respectively. Live birth rate per cycle was 17.4%, 15.7% and 15.9%, respectively. There were no significant differences in clinical pregnancies per cycle, as well as miscarriages and live births (p=0.30; 0.30; 0.60, respectively). The sperm-washing technique with ICSI may generate a promising way to improve pregnancy outcomes and to reduce the risk of viral transmission in these couples. In this setting, we can correctly counsel HIV- and HCV-infected men of SDCs with regard to the likelihood of father their own biological child.

The prevalence of other sexually transmitted infections in confirmed HIV cases at a referral clinic in Jamaica

Jamaica has the second highest number of acquired immunodeficiency syndrome (AIDS) cases and deaths in the Caribbean and a significant number of human immunodeficiency virus (HIV) infected individuals have a concomitant sexually transmitted infection (STI). The study determined the prevalence of non-ulcerative and ulcerative STIs and their association with sexual risky behaviour in a sample of HIV seropositive men and women. This study was conducted at the Comprehensive Health Centre in Jamaica, a sexually transmitted infection referral centre. The sample comprised 138 men and 132 women age 15-49 years, of average 29.5 years. The study was retrospective, from 2000 to 2002, and sample collection was randomized. The sexual behaviours of the subjects were assessed from the case records. In the 270 HIV diagnosed cases examined, the prevalence of STIs was 51.1% in men and 48.9% in women, with 85.4% having one or more STIs with an average of four STIs per patient. There was a total occurrence of 744 STIs with non-gonococcal urethritis (19.4%), gonorrhoea (17.2%), candidiasis (13.4%), trichomonas (12.4%), genital ulcer (10.4%) and syphilis (7.3%) the most common in HIV infected men and women. The presence of STI was associated with continued practice of risky sexual behaviour. The age group most implicated was the 30-34 year old, and 73.1% of the HIV infected patients had multiple sexual partners with only 16.4% reporting frequent condom use. The study demonstrates that there is a high prevalence of non-ulcerative and to a lesser extent ulcerative STIs in HIV infected patients in Jamaica. There are significant associations between STIs and continued high risk sexual practices in HIV infected men and women. The findings support the need for implementation of effective diagnosis and treatment strategies coupled with education about safe-sex practices in HIV prevention and STI control programmes.

Gynaecomastia, hyperprolactinaemia and HIV infection

Endocrine complications of human immunodeficiency virus (HIV) and its treatment are being increasingly recognized. We discuss the diagnosis and management of an HIV seropositive man who presented with bilateral gynaecomastia and 'hyperprolactinaemia' due to macroprolactin within six months of starting antiretroviral therapy. We suggest that the gynaecomastia may be a feature of immune reconstitution disease. Measurement of serum prolactin in the investigation of gynaecomastia should be reserved for those with hypogonadotrophic hypogonadism. Since macroprolactin contributes to circulating prolactin in HIV-seropositive subjects, hyperprolactinaemic samples in these patients should be tested for macroprolactin.

Brachial Amyotrophic Diplegia in a Patient With Human Immunodeficiency Virus Infection

Although amyotrophic lateral sclerosis and progressive spinal muscular atrophy have been recognized to occur in association with human immunodeficiency virus infection, to our knowledge, brachial amyotrophic diplegia, a form of segmental motor neuron disease, has not been previously reported. Brachial amyotrophic diplegia results in severe lower motor neuron weakness and atrophy of the upper extremities in the absence of bulbar or lower extremity involvement, pyramidal features, bowel and bladder incontinence, and sensory loss. We describe a human immunodeficiency virus-seropositive man without severe immunosuppression or prior AIDS-defining illnesses who had brachial amyotrophic diplegia. This disorder may represent one end of a spectrum of motor neuron diseases occurring with this retrovirus infection.

Reversible azoospermia: anabolic steroids may profoundly affect human immunodeficiency virus–seropositive men undergoing assisted reproduction

Background In vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) has recently been offered to human immunodeficiency virus (HIV)–serodiscordant couples where the man is seropositive and the woman seronegative to achieve pregnancy while minimizing the risk of HIV transmission. Anabolic steroids are commonly prescribed medications for adjunctive treatment of HIV disease to prevent muscle wasting. Case An HIV-serodiscordant couple presented for fertility care and evaluation. The man was found to be azoospermic. Further evaluation attributed his azoospermia to his treatment with testosterone and oxandrolone. After these agents were discontinued, his azoospermia resolved within 3 months. Normal sperm were then cryopreserved for future use, and his medications were resumed. Later the couple conceived by IVF-ICSI using the cryopreserved sperm. Conclusion The popular use of anabolic steroids in HIV-infected men may predispose them to abnormal sperm production.

A survey of sexual activity in HIV-positive gay men

The aim of this study was to explore the sociopsychological influences that affect decision-making processes regarding sexual practice before and after becoming infected with the human immunodeficiency virus (HIV). It was hoped to identify and describe the factors that influence sexual practices using multiple regression methods and to explore in more detail, using qualitative methods, the issues for gay men. The study randomised participants to complete a questionnaire which included the short General Health Questionnaire (GHQ-12) and the National Survey of Sexual Attitudes and Lifestyles (NASSAL) questionnaire; carried out in-depth semi-structured interviews and invited participants to take part in a focus group. The study was undertaken in an HIV clinic in South London, and completed data from 60 gay HIV seropositive men were included. Contracting HIV results in a complex disease process, and multiple factors may influence behaviour in sexual practices. Using stepwise regression, the study indicated that the strongest predictor of present and intended future sexual behaviours was past sexual behaviour. The other variable measures were weakly correlated and therefore not significant. These results indicate that innovative methods to increase condom use in men during their first sexual experiences have to be considered. Although this applies to all age ranges, from this study, younger men (under 20 years) who were experiencing their first exposures to homosexual lifestyle were considered more at risk for learning unsafe sexual behaviours from older sexual partners.

I'm not a "basabasa" woman: an explanatory model of HIV illness in Ghanaian women.

Ghana continues to experience an increase in the rate of infection with the human immunodeficiency virus (HIV), with more new infections occurring in women than in men. Prevailing views of health and illness, including indigenous knowledge and traditional beliefs, are an important component of the broad context of disease transmission. Participatory action research was used to explore the explanatory model of HIV illness of 31 seropositive Ghanaian women. Also interviewed were 5 HIV seropositive men, 2 traditional healers, 8 nurses, and 10 professionals, individually and in focus groups, to reflect on the women's comments and the themes emerging from the data. In this article, the women's beliefs about HIV illness will be discussed and their views about the etiology, pathophysiology, symptomology, course of illness, and methods of treatment for their illness will be described. Findings illustrate areas of divergence and convergence between traditional and biomedical explanations of, and treatment for, HIV illness. The necessity for health professionals, particularly nurses, to understand individual and community perceptions about HIV illness is highlighted by the study findings.

Psychiatric disorder in HIV infection.

This study aimed to investigate rates of psychiatric disorder in human immunodeficiency virus (HIV) infection, in an Australian sample of homosexual and bisexual men. A cross-sectional study of a total of 65 HIV sero-negative (HIV-) and 164 HIV sero-positive men (HIV+) (79 CDC stage II/III and 85 CDC stage IV) was conducted in three centres. Lifetime and current prevalence rates of psychiatric disorder were evaluated using the Diagnostic Interview Schedule Version IIIR (DIS-IIIR). Elevated current and lifetime rates of major depression were detected in both HIV negative and HIV positive homosexual/bisexual men. Lifetime rates of alcohol abuse/dependence were significantly elevated in HIV positive men (CDC group IV) when compared with HIV negative men. Among the HIV positive group the majority of psychiatric disorders detected were preceded by a pre-HIV diagnosis of psychiatric disorder. Major depression represented the disorder most likely to have first onset after HIV infection diagnosis. Lifetime rates of major depression were elevated in this sample of HIV-negative and HIV-positive men. In the HIV-positive men, psychiatric disorder was significantly associated with the presence of lifetime psychiatric disorder prior to HIV infection diagnosis. The findings indicate the importance of evaluation of psychiatric history prior to HIV infection and the clinical significance of depressive syndromes in this population.

DETECTION OF HIV INFECTION IN MEN SUFFERING FROM SEXUALLY TRANSMITTED DISEASES IN NORTH EAST REGION

In a prospective study, 715 men in the age group 18-45 years with various sexually transmitted diseases (STD) from Jan 1993 to June 1996 were examined for presence of human immunodeficiency virus (HIV) infection. Majority (86%) were young adults in the age group of 21-35 years. Five hundred and fifty eight (78.04%) men were married and 157 (21.9%) were single. Majority men (87.3%) gave history of heterosexual exposures with female commercial sex workers. None had used condom during sexual intercourse. Out of 715, majority (30.9%) cases had chancroid. Blood samples were tested for HIV 1-2 antibodies during treatment and surveillance period by Enzyme Linked Immunosorbent Assay (ELISA) technique. Nine cases of STDs were positive for HIV 1-2 antibodies by ELISA test and 8 (1.1%) were confirmed by Western blot assay. All HIV seropositive men got infection from female commercial sex workers which were detected during their surveillance period. This study highlights the importance of screening of STD patients for HIV infection during treatment as well as surveillance period.

Nasopharyngeal flora in HIV seropositive men who have sex with men.

OBJECTIVES: To assess, in men who were infected with the human immunodeficiency virus (HIV) and who identified themselves as having had sex with men; the nasopharyngeal prevalence of Neisseria gonorrhoeae,...

Social relationships and immune processes in HIV seropositive gay and bisexual men.

This three-year longitudinal study assessed the association between social relationships and human immunodeficiency virus (HIV) progression in individuals at risk for morbidity and mortality due to acquired immune deficiency syndrome (AIDS). Two-hundred five HIV seropositive men without AIDS completed measures of social integration and loneliness at baseline. Blood samples used to assess CD4 T-lymphocyte levels were collected at baseline and at six-month intervals for a three-year follow-up period. Contrary to expectation, lower levels of baseline loneliness predicted more rapid declines in CD4 levels over the follow-up period. This association was independent of baseline CD4 values, negative affect, and health practices. A series of mediational analyses revealed that sexual behavior, medication use, bereavement, coping, and a number of other variables were not mechanisms through which loneliness affected the immune system. Loneliness was not associated with time to AIDS diagnosis or time to AIDS-related mortality. These findings are consistent with the emerging view that social relationships can have deleterious, as well as protective, influences on health outcomes.

Human immunodeficiency virus (HIV) infection and quality of life: the potential impact of Axis I psychiatric disorders in a sample of 95 HIV seropositive men.

The purpose of this study is to assess whether Axis I psychiatric disorders exert effects on function and well-being independent of human immunodeficiency virus (HIV)-related disease progression. A convenience sample of 95 HIV seropositive individuals completed the Medical Outcomes Study Short Form Health Survey (SF-20). The Standardized Clinical Interview for DSM-III-R (SCID-NP-HIV) was used to screen subjects for Axis I psychiatric disorders in the previous 6 months. HIV-related disease severity was defined for each subject using the 1993 revised Centers for Disease Control (CDC) Classification System. Thirty-seven (39%) subjects had asymptomatic HIV disease and 58 (61%) had symptomatic disease. Thirty-three (35%) subjects had Axis I disorders in the previous 6 months. After controlling for HIV-related disease severity, psychiatric disorders were independently associated with substantive decrements in the mental health and health perceptions dimension scores (beta-coefficients were approximately -18.0 for both dimensions; p < or = 0.01). Axis I disorders were also associated with decrements in the social functioning dimension at a p value that approached significance (p = 0.04). In HIV seropositive individuals, the presence of an Axis I psychiatric disorder in the previous 6 months is associated with diminished scores in multiple areas of functioning and well-being, independent of HIV-related disease progression. Axis I disorders, therefore, appear to impact quality of life. These findings, in part, suggest that the SF-20 (the mental health subscale, in particular) may have utility as a screening tool for the presence of a recent Axis I diagnosis.

A Quantitative MRI Study of the Basal Ganglia in Depression in HIV Seropositive Men

HIV (Human Immunodeficiency Virus) infection is associated with high rates of depressive symptomatology. There is evidence that such infection is associated with damage to the basal ganglia. It has also been suggested that the basal ganglia are implicated in the aetiology of affective disorders. This study examined the association between basal ganglia atrophy and depression in HIV seropositive men. We hypothesized that depressed HIV seropositive patients would have smaller basal ganglia compared with nondepressed HIV positive comparison subjects. Using quantitative magnetic resonance imaging (MRI) techniques we compared for the basal ganglia volumes of sixteen depressed, and sixteen group-matched nondepressed HIV seropositive homosexual men. We found no significant difference in basal ganglia volumes between the two groups. We suggest that depression, at least in the early stages of HIV infection, is not associated with basal ganglia atrophy.

A pilot intervention program that reduces psychological symptomatology in individuals with human immunodeficiency virus

Background : Thirty-eight human immunodeficiency virus-seropositive men and women, most with AIDS, enrolled in a psychological intervention, called the HeartMath ® program. It is a unique intervention for stress-reduction and mental and emotional self-management that focuses on enhancing positive emotional states, as well as minimizing negative states. Objective : This pilot study was conducted to determine the feasibility of this program in managing the psychological status and improving the quality of life of individuals with human immunodeficiency virus. The study was not intended to be a large, double-blind, controlled clinical study. Methods : Participants attended three 2-day training sessions and were given home study assignments of approximately one hour per day for the six-month study period. They were assessed on site prior to and at the completion of the six-month period using (i) an Irritability Scale, (ii) a Symptom Questionnaire developed to assess the number and severity of symptoms specifically associated with acquired immune deficiency syndrome, (iii) the State-Trait Anxiety Inventory, (iv) the General Well-Being Scale, and (v) the Essi Systems StressMap ® Research Tool. Results : The data indicate that the program is highly effective in reducing symptomatology in individuals with human immunodeficiency virus by decreasing state and trait anxiety, improving physical vitality, reducing stress, and improving overall psychological well-being. Some individuals also reported improvements in physical symptomatology. Conclusions : The results indicate that the HeartMath program is a non-pharmaceutical intervention that can positively affect the psychological well-being of individuals with acquired immune deficiency syndrome.

Adequately Treated Remote SyphilisDoes Not AugmentCNS HIV-1 Expression.

The co-occurence of human immunodeficiency virus (HIV) infection and syphilis may accelerate the course of both infections. We investigated whether remote syphilis infection augmented the activation of central nervous system (CNS) HIV infection and increased the frequency of cerebrospinal fluid (CSF) abnormalities. The subjects consist of HIV seropositive men who had CSF as part of prospective neurological studies performed at the Johns Hopkins University. Prior syphilis infection was determined by measuring serum FTA-ABS. All subjects had received adequate treatment for syphilis with negative RPR's or RPR's &le; 1:8 and completed a full neurological examination and underwent lumbar punctures for analysis of cerebrospinal fluid. A range of CSF tests were performed including HIV culture, p24 antigen, &beta;2 microglobulin (&beta;2M) and CSF/albumin ratios. The FTA positive group was significantly older (p = .005), more advanced in HIV clinical staging (p = .04), had more minor neurological symptoms (p = .03), and was more likely to be on antiretroviral therapy (p = .03). No differences between FTA positive and FTA negative groups were observed either in the frequency of CFS anbormalities or the mean CSF values. Based on these findings, it appears that adequately treated remote syphilis does not augment HIV-1 expression within the CNS.

Semen analysis in HTV seropositive men and in subjects at high risk for HTV infection

The main purpose of this research was (i) to perform a comparative study of sperm parameters in human immunodeficiency virus (HIV) seropositive and high risk subjects in order to identify any possible alterations in the semen which specifically result from HIV infection and (ii) to study the p24 antigen as an early diagnostic marker of infection in high risk subjects. HIV seropositive subjects showed no significant variations regarding sperm densities, motility and viscosity compared to high risk subjects and controls. On the other hand, these HIV seropositive subjects showed (a) a significantly higher percentage of cytoplasmic droplet forms and immature germ cells, perhaps caused by an early failure of epididymal function and/or by a condition of stress affecting spermatogenesis after HIV infection and (b) a significantly higher level of spermiophage cells, suggesting that HIV activates mechanisms that increase spermiophagy. In addition, HIV seropositive men showed a significant positive correlation between blood CD4+ and sperm motility as well as a significant inverse correlation between CD4+ and sperm abnormalities. This is perhaps due to a decrease in testosteronaemia leading to defective epididymal sperm maturation. To date, p24 has not been found in the serum or seminal plasma of high risk subjects. The longitudinal study in progress should provide further information on this point.

Repeated bereavement, depressed mood, and immune parameters in HIV seropositive and seronegative gay men.

The relationships among bereavement, depressed mood, and immunologic patterns prognostic for the development of acquired immunodeficiency syndrome (AIDS) were determined in a sample of human immunodeficiency virus (HIV) seropositive gay men and a comparison group of HIV seronegative gay men. Immunologic parameters were assessed in 45 men who had recently experienced the deaths of close friends and 45 matched nonbereaved men. No immune differences were found between bereaved and nonbereaved men. Among the HIV seropositive nonbereaved men, higher depressed mood was significantly associated with fewer CD4 (helper/inducer) T lymphocytes, more activated CD8 (suppressor/cytotoxic) T cells, and lower proliferative responses to the mitogen phytohemagglutinin. In summary, HIV seropositive men who reported higher levels of depressed mood not associated with bereavement demonstrated immunologic patterns consistent with HIV activity and progression.

An Estimate of the Prevalence of Human Immunodeficiency Virus Infection in England and Wales by using a Direct Method

Knowledge of the number of human immunodeficiency virus (HIV) seropositive people in a country and of their distribution in different transmission categories is important for health care planning, for risk estimations and for targeting public health interventions. We used data on seroprevalence of antibody to HIV in defined subgroups of the population attained from unlinked anonymous HIV testing surveys and combined these with estimates of the respective sizes of these subgroups from an interview study on sexual attitudes and lifestyles. Seroprevalence in those subgroups not covered by the HIV testing surveys was derived from a series of assumptions and approximations. The estimated numbers of HIV seropositive subjects in each subgroup were added to give an overall total for England and Wales at the end of 1991. The overall estimate was 27180 HIV seropositive people, with lower and upper bounds of 20200 and 34300 respectively. Homosexual and bisexual men were estimated to constitute about half of the total number who were seropositive, and heterosexually infected people constituted approximately a quarter. The greatest numerical uncertainties applied to the number of HIV seropositive men who have had a male partner, but not in the last 5 years, and to the number of HIV seropositive heterosexual men and women who have no recognized risk behaviour. Overlap between the various subgroups defined by unlinked anonymous testing programmes is substantial, but could partly be adjusted for with data from the interview study. The estimates of this study are in the same range as those made earlier with this and other modelling strategies.

The effects of social support on Hopkins Symptom Checklist-assessed depression and distress in a cohort of human immunodeficiency virus-positive and -negative gay men. A longitudinal study at six time points.

Questionnaire data were collected from a panel of 342 gay men at risk for acquired immune deficiency syndrome enrolled in the Coping and Change Study between 1985 and 1987, and 1988 and 1990. Data were obtained across a period of 5 years in six serial wave pairs to determine the relationship of social support to Hopkins Symptom Checklist-assessed subsequent depression and general distress and to investigate whether the trends observed were stable or transient over time. Both objective and subjective components of social support demonstrated dramatic within-person stability over time (r = .47 to .86). A measure of subjective social support was modestly but significantly associated with lower depression at four of the six time periods and a lower level of general distress at one time period. Before appropriately controlling for current depression, subjective social support appeared to account for up to a third of the variance in future depression; after such controls were included in the regression equation, it became apparent that the independent contribution of support only ranged from 4% to 6% across the study period. This emphasizes the importance of including current mental health in longitudinal analyses. The respondents' social participation and involvement with others did not affect either depression or general distress at any time during the study period. These results indicate that while social participation may have no effect, subjective social support appears to influence often mental health in this cohort. Furthermore, human immunodeficiency virus seropositive men may at times benefit from such support.