Hepatitis C virus infection in a male homosexual cohort: risk factor analysis.

BACKGROUND: Hepatitis C virus (HCV) infection is a major cause of morbidity throughout the world. Parenteral exposure to infected blood accounts for the majority of cases. Sexual transmission is suggested by the higher prevalence of infection in sex workers and homosexual men. Sexual practices which contribute to HCV infection need to be identified. METHODS: The social and medical history, and HCV serostatus of 1058 homosexual men in the Pittsburgh arm of the Multicenter AIDS Cohort Study were analysed. Multivariate analysis was used to determine risk factors for HCV seropositivity. RESULTS: 31 men were HCV seropositive by enzyme immunoassay and recombinant immunoblot assay (2.9%). They were more likely to be HIV seropositive (39%) than the HCV seronegative men (19%). Needle sharing and illegal drug use were the most important risk factors for HCV seropositivity. Statistically significant sexual factors (p < 0.05) included a history of syphilis, rectal gonorrhea, anal insertive intercourse with ejaculation, and douche or enema use before anal receptive intercourse. The number of sexual partners was not a significant risk factor. CONCLUSIONS: HCV infection is associated with specific sexually transmitted diseases (STDs) and sexual practices in the male homosexual population. The evidence of high risk behavior should be incorporated into ongoing educational efforts to decrease the incidence of STDs.

Changes in HIV rates and sexual behavior among homosexual men, 1984 to 1988/92.

Data were collected from 1614 homosexual and bisexual men in 1984 through 1985 and from 1988 to 1992 in Pittsburgh. Of the men entering the study since 1988, 16% reported engaging in unprotected anal receptive intercourse with more than one partner during the 6 months before their visit. Approximately 7% of the younger men and 18% of the men over 22 years of age in the recent cohort were already infected with the human immunodeficiency virus, the same rates as those described 8 years ago. Aggressive risk-reduction programs are needed in high schools and existing networks in the gay community.

Temporal trends in human immunodeficiency virus type 1 seroconversion 1984-1989. A report from the Multicenter AIDS Cohort Study (MACS).

The 5-year temporal trends in human immunodeficiency virus type 1 (HIV-1) seroconversion between 1984 and 1989 among homosexual/bisexual men participating in the Multicenter AIDS Cohort Study (MACS) are reported. Of 3,262 initially seronegative men, 368 (11.3%) had seroconverted by December 31, 1989. Although the incidence of seroconversion declined precipitously during the first 3 years of follow-up (from 4.1% to 0.9% per 6 months), no evidence for a further substantial reduction was noted after mid-1987, since 6-month incidence rates ranged between 0.5% and 1.2%. The Chicago cohort experienced an increase in HIV-1 seroconversion during both semesters of 1989; 2.1% and 1.6% per 6 months, respectively, became newly infected. Other MACS centers did not report such an increase. Center-specific differences were observed by race; black men were at higher seroconversion risk than white men in Baltimore/Washington (relative risk (RR) = 3.4) and Chicago (RR = 2.4), while Hispanic men were at higher risk than white men in Chicago (RR = 3.3). Younger age (less than 35 years) was also associated with HIV-1 seroconversion (RR = 1.5). It is disturbing to report an overall annual seroconversion rate of 1.2% for the 2 years prior to December 31, 1989, as well as evidence for a sustained recent increase in Chicago during 1989. Long-term maintenance of safe-sex behaviors should be the cornerstone of acquired immunodeficiency syndrome prevention among homosexual/bisexual men.

Cumulative risk for AIDS and other HIV outcomes in a cohort of hemophiliacs in western Pennsylvania.

The role of age on the risk of developing AIDS and on survival once AIDS occurs was studied in a cohort of HIV(+) hemophiliacs (n = 84), on whom HIV seroconversion dates and clinical endpoints were known. The Kaplan-Meier estimates of the proportion developing AIDS were 12, 28, and 49% by 4, 6, and 7 1/2 years' duration of infection, respectively. The proportion developing AIDS by 6 years after infection was estimated to be 49, 24, and 5% for those greater than 30 years of age at seroconversion, between 18 and 30, and 18 and under, respectively (p less than 0.002). The proportion estimated to have a fatal outcome by 0.5, 1.0, and 1.5 years after AIDS diagnosis was 64, 76, and 88%, respectively, for those over 40 at seroconversion, which was significantly greater than 33, 48, and 81, respectively, for those less than or equal to 40 (p less than 0.01). In conclusion, (a) nearly half of this cohort is estimated to develop AIDS by 7 1/2 years' duration of infection, and (b) older age is associated with significantly shorter time to AIDS and shorter survival once AIDS occurs.

HIV transmission to female sexual partners of HIV antibody-positive hemophiliacs.

To study heterosexual transmission of the human immunodeficiency virus (HIV), 21 HIV antibody-positive hemophiliacs and their 21 spouses-sexual partners were evaluated. None belonged to other AIDS risk groups. HIV antibody was detected in four (19 percent) of the female partners. HIV was isolated from peripheral blood lymphocytes of one hemophiliac (4.8 percent), and one female partner (4.8) was antibody-positive. None of the couples engaged in anal intercourse. Compared with HIV antibody-negative female partners, HIV antibody-positive female partners were younger (P less than .05), had younger hemophiliac partners (P less than .05), and were likely (although not significantly so) to engage in oral sex (P = .08) and to have had more than one sexual partner in the previous 5 years (P = .08). Condoms were used all the time by only eight couples (40 percent), and pregnancy occurred in two other couples (9.5 percent), despite prior counseling. These data confirm the low frequency of heterosexual transmission of HIV from HIV antibody-positive hemophiliacs to their female sexual partners and suggest, moreover, that this may be due to the low rate of HIV infectivity in HIV seropositive hemophiliacs exposed to HIV. Further, these data document the need to design more effective educational programs to prevent heterosexual transmission of HIV.