Search

Young gay men are at high risk for HIV infection, and appropriate participants for HIV vaccine research trials. Researchers surveyed 2,189 gay and bisexual men, and found that those under 25 years of age were twice as likely to be HIV-infected as older men. Most of the surveyed men were willing to take part in vaccine research. Young gay men were less knowledgeable about vaccine concepts, and perceived themselves to be at higher risk of HIV infection from high-risk behavior, than older men. Young men reported they may engage in more high-risk behavior if vaccinated against HIV.

This study investigated the willingness of gay males in Chicago, San Francisco and Denver to participate in an HIV vaccine efficiency test. Those more willing tended to be less educated, white, older, engaged in HIV risk activity, and live in Denver.

Background and Objective: 'High-risk' types of genital human papillomavirus (HPV) infections are associated with anogenital cancer. As these cancers occur more frequently in immunosuppressed individuals, we sought to better characterize type-specific prevalence, clinical spectrum, and risk factors for anal HPV infection among homosexual men. Study Design: Cross-sectional and follow-up study of 93 (HIV)-seropositive (HIV+) and 116 Hiv-seronegative (HIV-) homosexual/bisexual men, with testing of anal swabs for HPV DNA by Virapap/Viratype assay. Results: Overall, 57 (61%) HIV+ and 20 (17%) HIV- men had anal HPV detected (P < .0001). HPV types 16/18 were most common, accounting for more than 50% of infections. Among HIV + men, HPV prevalence increased with declining CD4 cell count: 33% with counts of more than 750, 56% with counts of 200 to 750, and 86% with counts less than 200 (P = .01). HPV infection was also associated with younger age and increasing numbers of lifetime sexual partners for all men. Most infections were subclinical, with clinically apparent infection (anal warts) accounting for 35% of infections in HIV- men, 33% in asymptomatic HIV+ men, and 52% in men with AIDS/ARC. For both HIV- and HIV+ men, rates of anal HPV detection (23% and 60%) were greater than those for the perianal area (5% and 37%) or penile shaft (2% and 7%) (P, HIV-positive homosexual and bisexual men are likely to have anal infections with cancer-causing varieties of the human papillomavirus (HPV), the cause of genital warts. A group of 93 HIV-positive and 116 HIV-negative homosexual or bisexual men have been examined every six months since 1988. Overall, 61% of HIV-positive and 17% of HIV-negative men tested positive for anal HPV. Among HIV-positive men, the prevalence of HPV increased as CD4 counts decreased. HIV-positive men were 3.5 times more likely to test positive for HPV than HIV-negative men. HPV types 16 18, the types most strongly associated with cancer, accounted for over half the infections. It is thought that the increasing prevalence of HPV with declining CD4 cell counts is due to the decreasing ability of the immune system to keep the latent virus in check. With increasing lifespan among HIV patients, it is possible that anal cancer may become another opportunistic disease among homosexual bisexual men.

It is known that hepatitis B virus (HBV) and human immunodeficiency virus type 1 (HIV-1) are transmitted in similar ways and target similar populations in the United States. While HBV was once commonly seen in persons at risk for HIV-1 infection, it is now also commonly seen to develop after/simultaneously with diagnosis of HIV-1. Because of compromised immune response that accompanies HIV infection, HIV-1-infected patients with HBV have more difficulty fighting the HBV. To better understand the course of HBV infection in HIV-1-infected and HIV-1-negative men, a study was conducted using participants in a hepatitis B vaccine trial for data collection. In HIV-1-negative men it was found that the vaccination worked effectively against HBV infection or severity and its value increased with repeated vaccinations. Those previously infected with HIV-1 had a poorer response to the vaccine and HBV infection tended to be more serious than in non-HIV-1-infected men. Interestingly, it was found that HIV-1-infected men who were vaccinated tended to develop the most severe HBV-related symptoms of all groups, suggesting that the HBV vaccine may temporarily impair immune response to HBV infection in these men. (Consumer Summary produced by Reliance Medical Information, Inc.)

All new patients who attend sexually transmitted disease (STD) clinics are screened for gonorrhea (Neisseria gonorrhoeae infection) and syphilis. However, routine screening for Chlamydia trachomatis infections is expensive and is not commonly done. Risk factors associated with chlamydial infections include: having gonorrhea; inflammation of the urethra, cervix, testis, and pelvis; and contact with a person who has any of these conditions. However, most of the people who go to STD clinics do not have these conditions. Since chlamydial infections are common and can go undetected (because they often produce no symptoms), the incidence and laboratory tests for chlamydia infection were evaluated in a group of 438 men attending an STD clinic. Cotton swabs were used to take samples from the urethra to be analyzed by gram stain (a dye used to identify specific bacteria), and urine samples were collected and analyzed. Symptoms of chlamydia infection were present in 184 of the men, and the other 254 had no symptoms. Of the 438 patients, 29 (7 percent) tested positive for Chlamydia trachomatis and six (1 percent) tested positive for Neisseria gonorrhoeae. It is noted that the gram-stain test and urine test are not sufficiently sensitive, and underestimate the rate of chlamydial infection. The factors that were related to infection with chlamydia were age under 21 years and having had a total of five or more different sexual partners. It is concluded that more effective screening methods for chlamydia infection are needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Labor that begins too early in gestation, leading to the delivery of premature infants, is the most important cause of death and complications associated with childbirth. Unfortunately, medical understanding of the physiologic processes that lead to prematurity is incomplete. Infections in the reproductive tract are associated with premature rupture of membranes (PROM; rupture of the membranes that surround the fetus) and with prematurity, but studies of the association have not found consistent relationships. To learn more about this issue, a prospective study was carried out of 196 pregnant women (approximately 24 weeks' gestation) at two prenatal clinics. Specimens were collected from the endocervix (within the cervical canal) and the vagina, and transferred to culture dishes to allow bacterial growth. Tests were also performed for bacterial vaginosis (inflammation due to Gardnerella vaginalis, a microorganism), Mobiluncus species, Trichomonas vaginalis, yeast, and vaginal pH (acidity). Just under 17 percent of the pregnancies (33 patients) among this low-income group of women resulted in preterm labor. Twenty underwent tocolytic therapy (drugs to inhibit uterine contractions), and nine ultimately delivered premature infants. No infants died near the time of delivery; three were born with minor birth defects. Risk factors for preterm labor included previous preterm birth (the strongest factor), medical problems (asthma, frequent urinary tract infections), or a history of three or more abortions. Bacterial vaginosis was associated with increased risk, and the risk for women with this condition and Mobiluncus species was still higher. Mycoplasma hominis and Staphylococcus aureus infection were also implicated. The presence of more than one infection increased the risk of preterm birth considerably. Finally, an increased concentration of proteases (proteins that are released by bacteria) in fluid washed through the vagina was associated with increased risk. Whether elimination of these common vaginal microorganisms can reduce the incidence of preterm birth remains to be determined. (Consumer Summary produced by Reliance Medical Information, Inc.)

Between 15 and 20 percent of infants born prematurely die as newborns; prevention of prematurity is therefore a highly desirable goal. Infections in the cervix and vagina (often associated with inflammation, or vaginitis) have been identified as possible causes of premature labor, premature delivery, and premature rupture of the amniotic membranes, which surround the fetus. Evidence exists that antibiotic treatment of women infected with certain organisms reduces the frequency of these complications. A group of 229 inner-city pregnant women with gestational ages between 26 and 30 weeks was studied. The rate of prematurity in such populations was known to be between 16 and 20 percent. After vaginal examination and evaluation of vaginal specimens confirmed the presence of microorganisms, the subjects were randomly assigned to receive either the antibiotic erythromycin (119 women) or a placebo (110 women). Subjects took these drugs three times daily for one week; their pregnancy outcomes were subsequently monitored. In addition, 75 women underwent follow-up examinations one month after the study began. Statistics concerning maternal health (vaginal bleeding, diabetes) are presented. No differences were found in the rates of premature labor, premature birth (all participants had a low rate of this complication), or low-birth-weight infants, as a function of antibiotic treatment. However, women who received placebo medication had a higher frequency (16 percent) of premature rupture of membranes than those who received erythromycin (6 percent). Many of the women failed to complete four or more days of their medication. An extensive discussion of the effects of vaginal infection is presented. Although erythromycin seemed to reduce the risk of premature rupture of membranes, its failure to be tolerated means it cannot be recommended at the present time for treating such a population. (Consumer Summary produced by Reliance Medical Information, Inc.)

High rates of human T-lymphotropic virus type I or II (HTLV-I/II) infection in the USA have been found among those undergoing multiple blood transfusions (2.8 percent), female prostitutes (6.7 percent), and intravenous (IV) drug users (7 to 49 percent). HTLV can be transmitted in ways similar to HIV. To determine the prevalence of HTLV infection, patients attending a sexually transmitted disease clinic were serologically tested for HTLV. Blood samples from 585 patients living in Denver were tested for antibody to HTLV I/II. Of these patients, 384 had a history of IV drug use. None of the non-IV drug users had antibodies to HTLV. However, 2.1 percent of the IV drug users tested positive for HTLV. In another study, 1,095 serum samples were collected from sexually transmitted disease clinics in Georgia, Tennessee, North and South Carolina, and Alabama. HTLV antibodies were found in 2 out of 1,095 blood samples. It is concluded that HTLV is not prevalent in the southeastern United States, and that IV drug use is associated with HTLV infection. (Consumer Summary produced by Reliance Medical Information, Inc.)