Seminal fluid excretion of cytomegalovirus related to immunosuppression in homosexual men

Latent tuberculosis: interaction of virulence factors in Mycobacterium tuberculosis

Tuberculosis (TB) remains a prominent health concern worldwide. Besides extensive research and vaccinations available, attempts to control the pandemic are cumbersome due to the complex physiology of Mycobacterium tuberculosis (Mtb). Alongside the emergence of drug-resistant TB, latent TB has worsened the condition. The tubercle bacilli are unusually behaved and successful with its strategies to modulate genes to evade host immune system and persist within macrophages. Under latent/unfavorable conditions, Mtb conceals itself from immune system and modulates its genes. Among many intracellular modulated genes, important are those involved in cell entry, fatty acid degradation, mycolic acid synthesis, phagosome acidification inhibition, inhibition of phagosome-lysosome complex and chaperon protein modulation. Though the study on these genes date back to early times of TB, an insight on their inter-relation within and to newly evolved genes are still required. This review focuses on the findings and discussions on these genes, possible mechanism, credibility as target for novel drugs and repurposed drugs and their interaction that enables Mtb in survival, pathogenesis, resistance and latency.

Developmental disorders of the mouse brain induced by murine cytomegalovirus: animal models for congenital cytomegalovirus infection

Developmental disorders induced by congenital cytomegalovirus (CMV) infection mainly involve the central nervous system. The type and degree of the brain disorders seems to depend on infection time during gestation, virulence, route of infection and viral susceptible cells in each embryonal stage. Since transplacental transmission has been reported not to occur with murine CMV (MCMV), we developed mouse models for congenital CMV infection by surgical injection of MCMV into the mouse conceptus or embryo at different gestational stages. For the early stage, the mouse embryos were not infected with MCMV even after injecting the virus into the blastocysts, which were developed in the pseudo-pregnant mothers or cultured in vitro. Isolated whole mouse embryos of day 7.5 of gestation (E7.5), adsorbed with a high titer of MCMV and cultured for 3 days, were susceptible to MCMV infection. Therefore, the mouse embryo acquires the susceptibility around this period. Microphthalmia and cerebral atrophy were induced in mouse embryos after injection of MCMV into the conceptus on E8.5. Viral antigen-positive cells were widely distributed in the mesenchyme around the oral and nasal cavities and in the mesenchyme around the brain, especially the endothelial cells of vessels and the perivascular mesodermal cells, then infection extends to the eyes, brain or choroid plexus. This finding suggests that mesenchymal infection may be the critical step in disrupting organogenesis, resulting in brain disorders. For the late stage, mouse embryos were infected with MCMV by injecting the virus into the cerebral ventricles on E15.5. Brains of the offspring showed massive necrosis with gliomesodermal proliferation in the cerebral cortex. Viral antigen-positive cells were observed in laminar array in the lesion-free cortex and the hippocampus, suggesting that the infected cells migrate in association with the lamina formation. Immunohistochemical double-staining showed that brain cells susceptible to MCMV infection may be mainly neuronal and endothelial cells, resulting in cerebral atrophy with reduction of neuronal cells and cystic lesions, presumably due to ischemic vascular changes.

The Longevity of Homosexuals: Before and after the Aids Epidemic

Although the U.S. Surgeon General characterized homosexual sex as “normal” and “healthy,” homosexuals and IV drug abusers have suffered disproportionately from the AIDS epidemic. Longevity is often utilized as a measure of health. How long did homosexuals live before the AIDS epidemic and how long do they live today? We examined 6,737 obituaries/death notices from eighteen U.S. homosexual journals over the past thirteen years and compared them to obituaries from two conventional newspapers. The obituaries from the non-homosexual newspapers were similar to U.S. averages for longevity: the median age of death of married men was seventy-five, 80 percent died old (65 or older); for unmarried men it was fifty-seven, 32 percent died old; for married women it was seventy-nine, 85 percent died old; for unmarried women it was seventy-one, 60 percent died old. For the 6,574 homosexual deaths, the median age of death if AIDS was the cause was thirty-nine irrespective of whether or not the individual had a Long Time Sexual Partner [LTSP], 1 percent died old. For those 829 who died of non-AIDS causes the median age of death was forty-two (41 for those 315 with a LTSP and 43 for those 514 without) and <9 percent died old. Homosexuals more frequently met a violent end from accidental death, traffic death, suicide, and murder than men in general. The 163 lesbians registered a median age of death of forty-four (20% died old) and exhibited high rates of violent death and cancer as compared to women in general. Old homosexuals appear to have been proportionately less numerous than their non-homosexual counterparts in the scientific literature from 1858 to 1993. The pattern of early death evident in the homosexual obituaries is consistent with the pattern exhibited in the published surveys of homosexuals and intravenous drug abusers. Homosexuals may have experienced a short lifespan for the last 140 years; AIDS has apparently reduced it about 10 percent. Such an abbreviated lifespan puts the healthfulness of homosexuality in question.

Five myths about AIDS that have misdirected research and treatment

A number of widely repeated and factually incorrect myths have pervaded the AIDS research literature, misdirecting research and treatment. Five of the most outstanding are: 1) that all risk groups develop AIDS at the same rate following HIV infection; 2) that there are no true seroreversions following HIV infection; 3) that antibody is protective against HIV infection; 4) that the only way to treat AIDS effectively is through retroviral therapies; and 5) that since HIV is so highly correlated with AIDS incidence, it must be the sole necessary and sufficient cause of AIDS. A huge body of research, reviewed in this paper, demonstrates the falsity of these myths. 1) The average number of years between HIV infection and AIDS is greater than 20 years for mild hemophiliacs, 14 years for young severe hemophiliacs, 10 years for old severe hemophiliacs, 10 years for homosexual men, 6 years for transfusion patients of all ages, 2 years for transplant patients, and 6 months for perinatally infected infants. These differences can only be explained in terms of risk-group associated cofactors. 2) Seroreversions are common. Between 10 and 20 percent of HIV-seronegative people in high risk groups have T-cell immunity to HIV, and may have had one or more verified positive HIV antibody tests in the past. 3) Antibody, far from being protective against HIV, appears to be highly diagnostic of loss of immune regulation of HIV, and some evidence of antibody-enhancement of infection exists. 4) Non-retroviral treatments of HIV infection, including safer sex practices, elimination of drug use, high nutrient diets, and limited reexposure to HIV and its cofactors have proven to be effective means of preventing or delaying onset of AIDS. 5) Many immunosuppressive factors, including drug use, multiple concurrent infections, and exposure to alloantigens, are as highly correlated with AIDS risk groups as HIV. These data are more consistent with AIDS being a multifactorial or synergistic disease than a monofactorial one.

Enhanced shedding of cytomegalovirus in semen of human immunodeficiency virus-seropositive homosexual men

Site-specific shedding of cytomegalovirus (CMV) was assessed in a longitudinal study of homosexual and bisexual men. At initial testing, CMV was cultured from the semen of 33% (19 of 58) of asymptomatic and mildly symptomatic men who were seropositive for human immunodeficiency virus (HIV) at the time of entry into the study, whereas it was cultured from the semen of 17% (10 of 58) of the men who were HIV seronegative. CMV was isolated much more frequently from semen than from urine or throat washing specimens, and it was rarely recovered from stool or blood, regardless of the subject's HIV serostatus. CMV was cultured from the semen of 31% (16 of 52) of the men relatively early after seroconversion to HIV (mean, 12.8 months). CMV was persistently isolated from the semen of a greater proportion of the HIV-seropositive men than from the semen of the HIV-seronegative men during a 4.5-year follow-up period (52 of 110 - [47%] and 15 of 58 [26%] men, respectively). There was an increased relative risk for shedding of CMV in semen in association with decreased CD4+ cell numbers and increased levels of serum immunoglobulin A. However, there was no association of CMV shedding with an increased risk for the development of AIDS.

Genitourinary Pathologies during Hiv Infection

With the growing number of patients with Hiv infection there has been a marked increase in the incidence of unusual genitourinary pathologies. Urologists find themselves dealing with opportunistic infection (viral and fungal infection), penile and testicular neoplasm and neurological bladder. The Authors present their experience and describe the problems correlated with urogenital pathologies during Hiv infection.

Nuclear bodies (sphaeridia) in Sertoli cells of a man with acquired immunodeficiency syndrome (AIDS) and testicular infection by cytomegalovirus

Histological and ultrastructural study of an adult man with acquired immunodeficiency syndrome (AIDS) revealed multiple testicular lesions. The seminiferous tubules varied from dilated tubules with hypospermatogenesis, to tubules with Sertoli cells and a few spermatogonia, to necrotic tubules. The testicular interstitium showed abundant inflammatory infiltrates, some of them forming microabscesses. The Sertoli cells exhibited spherical intranuclear inclusions corresponding to both cytomegalovirus and sphaeridia. Some sphaeridia stained intensely with EDTA as granular and fibrillar portions of the nucleolus; however, many sphaeridia stained weakly as nucleolar fibrillar centers. These observations suggest that a Sertoli cell response to cytomegalovirus is the proliferation of nucleolar organizing centers that in some instances may transform to give rise to more or less abnormally developed nucleoli.

Testicular atrophy in AIDS: a study of 57 autopsy cases

The pertinent clinical data and histologic features of the testes in 57 autopsied acquired immunodeficiency syndrome (AIDS) patients were analyzed and compared with those of 55 age-matched control patients without AIDS. The testes of the AIDS patients showed a significantly lower degree of spermatogenesis (determined by a testicular score count), as well as more prominent thickening of the basement membrane and interstitial fibrosis when compared with the controls. While the precise cause of testicular atrophy in AIDS patients remains to be determined, the chronicity of the disease, prolonged fever, malnutrition, testicular infection, and chemotherapy are all contributing factors. Since the vast majority of the studied AIDS patients were homosexual and most control patients were heterosexual, the observed testicular changes can be ascribed to AIDS and/or homosexuality. Because of a high prevalence of sexually transmitted diseases, antisperm antibodies, and possible zinc deficiency and endocrine disorders, homosexual men appear predisposed to tubular atrophy. Conversely, AIDS-related factors, such as a direct toxic effect of the human immunodeficiency virus on germinal epithelium or as yet undetermined endocrine imbalances might exert a detrimental effect on the testis independent of homosexuality.

Virus isolation and immune studies in a cohort of homosexual men

Virus shedding was detected in 77% of homosexual subjects and in only 6% of heterosexual controls. The overall virus isolation rate in homosexual subjects was not significantly different among HIV-seropositive (79%) and HIV-seronegative (74%) individuals. In about 20% of homosexual subjects, virus shedding from multiple sites was observed. The most frequently isolated virus was cytomegalovirus (CMV) (41%), followed by enteroviruses (23%), herpes simplex virus (HSV) (7%), and adenoviruses (6%). In the control group, about 50% of subjects were seronegative for HSV-1 and 2, and about 70% were negative for CMV and Epstein-Barr virus (EBV). Only 2% of homosexuals were seronegative for CMV, about 5% for HSV-1 and 2, and about 20% for EBV. No differences were found in antibody levels against varicella-zoster virus (VZV) among the control and homosexual groups. The proportion of seronegatives for Coxsackie and hepatitis viruses was significantly higher in control than in homosexual subjects. However, no differences in the proportion of seronegatives for measles, mumps, and rubella were observed. No HIV-antibody-negative individual was detected with an OKT4/OKT8 ratio of less than 0.75. On the other hand, only HIV-positive subjects, with a ratio of less than 0.75, had high serum IFN alpha titers. The results suggest that the high rate of virus shedding among HIV-negative homosexual subjects might be a factor in the development of AIDS in this high-risk population.

Cytomegalovirus colitis and oesophageal ulceration in the context of AIDS: clinical manifestations and preliminary report of treatment with Foscarnet (phosphonoformate)

Three patients with biopsy diagnosed invasive cytomegalovirus infection of the colon have been seen in the context of the acquired immune deficiency syndrome (AIDS). Cytomegalovirus colitis presented with fever, abdominal distention, bloody diarrhoea and weight loss. Plain abdominal radiographs showed generalised large bowel dilatation in one patient. Cytomegalovirus infection was shown histologically, but the virus could not be cultured from the stool; no other gastrointestinal pathogens could be demonstrated. The patients were treated with a 14 day continuous infusion of Foscarnet 0.08 mg/kg/min (phosphonoformate, Astra Pharmaceuticals). One patient showed a partial response to therapy, but the cytomegalovirus colitis relapsed; the second patient had a symptomatic response only and the third patient died of non-cytomegalovirus opportunist infection while on treatment. Two other patients with biopsy proven cytomegalovirus ulceration of the oesophagus were seen, presenting with dysphagia, fever and weight loss. Invasive infection of the gastrointestinal tract with cytomegalovirus is now a major clinical problem in AIDS. Treatment with Foscarnet may be initially effective, but does not eliminate cytomegalovirus infection.

Cytomegalovirus infection in homosexual men. Relationship to sexual practices, antibody to human immunodeficiency virus, and cell-mediated immunity

To investigate the relationships among cytomegalovirus infection, sexual behavior, human immunodeficiency virus (HIV) seropositivity, and indexes of cellular immunity, 180 homosexual men and 26 heterosexual men were studied. Among the homosexual men, cytomegalovirus seropositivity was associated with increased T8 lymphocyte counts (p less than 0.001) and reduced T4/T8 ratios (p = 0.006); these results were independent of HIV infection. Cytomegalovirus seropositivity was also associated with increasing age, numbers of sexual partners, and the practice of anal-receptive intercourse. At the first visit, cytomegalovirus was isolated from none of 13 cytomegalovirus-seropositive heterosexual subjects, compared with 62 (36 percent) of 171 seropositive homosexual men (p less than 0.005). Viral isolation was most common from semen. Among 32 cytomegalovirus-seropositive homosexual subjects from whom culture specimens were obtained more than four times over 10 to 30 months, 72 percent of the specimens were culture-positive. The mean duration of cytomegalovirus excretion in semen was 22 months, and in urine, the duration was nine months. Cytomegalovirus excretion was associated with younger age and reduced lymphocyte proliferation in response to cytomegalovirus, but not with antibody to HIV. Cytomegalovirus infection is sexually transmitted among homosexual men, perhaps by rectal intercourse, and is associated with alterations in T lymphocyte subsets. Most seropositive homosexual men excrete cytomegalovirus intermittently, primarily in the semen.

Antiviral antibodies in the sera of homosexual men: correlation with their lifestyle and drug usage

Healthy homosexual men between the ages of 21 and 65 years, from the Washington, DC (n = 162), and New York City (n = 89) areas, were studied for antibodies in the serum against cytomegalovirus (CMV), herpes simplex virus (HSV) types 1 and 2, and Epstein Barr virus (EBV) viral capsid antigen (VCA). CMV-specific antibodies were assayed by enzyme-linked immunosorbent assay (ELISA), anti-HSV-1 and -2 antibodies were measured by indirect hemagglutination (IHA), and antibodies to EBV VCA were measured by the immunofluorescence assay. Antibodies to human T lymphotrophic virus III (HTLV-III) were detected by ELISA and Western blot procedures. T lymphocytes were enumerated using OKT4 monoclonal antibody. Healthy male volunteer blood donors (n = 90) matched for age range and race proportions were used as controls. The percentage of seropositive individuals in the homosexual group was higher (90-98%) for all the viruses tested than in the control group (47-87%). Comparisons of the geometric mean titers, expressed as reciprocal serum dilutions, of seropositive individuals in homosexual (H) vs control (C) group were as follows: CMV-IgG (ELISA) H = 1:794, C = 1:68; HSV-1 (IHA) H = 1:248, C = 1:14; HSV-2 (IHA) H = 1:56, C = 1:17; EBV-VCA (IFA) H = 1:385, C = 1:131. The homosexual group also showed a higher frequency of individuals with elevated titers than the control group. The CMV IgM antibody was prevalent in 17.7% of the homosexual group and 5% of the control group; arithmetic means for ELISA values for CMV IgM were 0.207 for the homosexual group and 0.05 for the control group. In the homosexual group, the anti-CMV antibody titers increased with age (P = 0.01) and with numbers of sex partners (P = 0.06). Both anti-HSV-1 and anti-HSV-2 antibodies correlated with the number of sex partners (P = 0.04 and P = 0.05, respectively). Neither age nor partner number correlated with response to EBV, and no particular sex act was related to the EBV VCA titer level. HTLV-III seropositivity was associated with higher herpes virus group antibody titers, probably because of life style cofactors. Among the HTLV-III-seropositive subjects, those with less than or equal to 400 T-helper lymphocytes/mm3 had lower antibody titers than those with greater than 400 T-helper lymphocytes/mm3 counts, suggesting an impaired immune response secondary to immunosuppression.

Cytomegaloviral epididymitis in a patient with the acquired immune deficiency syndrome

We report on a patient with cytomegaloviral epididymitis and the acquired immune deficiency syndrome. The diagnosis was suggested by epididymitis that was refractory to antibiotics, and by isolation of cytomegalovirus from the urine and semen. The definitive diagnosis was made with immunohistochemical staining for cytomegaloviral antigens in the epididymal ductal cells. Because of the ineffectiveness of antimicrobial agents in this disorder, epididymectomy is the current treatment of choice.

Elimination of toxicity and enhanced cytomegalovirus detection in cell cultures inoculated with semen from patients with acquired immunodeficiency syndrome

Although semen is a particularly rich source of cytomegalovirus (CMV) and is useful for monitoring CMV shedding, its culturing is associated with extensive monolayer toxicity, isolation failures, and lengthy detection times. Inoculation of fractionated semen with immunoperoxidase staining of monolayers eliminated virtually all toxicity, increased isolation rates and monolayer infectivity, and greatly reduced detection times. Semen specimens (n = 73) were processed conventionally (C) or separated into supernatant (SF) and cellular pellet (PF) fractions, and 35% of C and SF inocula produced extensive toxicity. In contrast, virtually no toxicity was observed in monolayers inoculated with PF. C and SF isolation rates were 41 of 73 and 38 of 73, respectively, whereas that for PF was 51 of 73. Although monolayer infectivity at initial CMV detection was often less than 10% for C and SF, it was as much as 25% for PF. Average detection times were reduced from 13 days for C and SF to 6 days with PF and were further reduced to 3 days when PF inoculation was combined with immunoperoxidase staining. Thirty percent of specimens negative by C were positive by PF.

Screening to reduce transmission of sexually transmitted diseases in semen used for artificial insemination

The practice of artificial insemination by donor semen is increasing in the United States. Many sexually transmitted organisms are found in semen, but screening procedures for the detection of these agents in donor semen have not been standardized. Sexually transmitted organisms have been transmitted during artificial insemination by donor, and such transmission can cause local, disseminated, or fatal disease in the recipient woman and may harm the fetus or newborn. Therefore, screening of both the donor and the donated semen is necessary to avoid infectious complications. Because semen samples cannot be evaluated completely on the day of donation, the use of fresh semen for artificial insemination should be discouraged. Until accurate, rapid diagnostic tests are available, only frozen semen that has been appropriately screened should be used.

Murine cytomegalovirus infection of mouse testes

With the aim of illustrating a mechanism of cytomegalovirus (CMV) venereal transmission, we induced murine CMV infection in the mouse testes of immunologically competent mice. Using in situ cytohybridization, we were able to show that murine CMV-specific DNA was associated with spermatocytes and mature sperm. Electron microscopy studies also supported sperm infection. The virus could be reisolated from infected epididymal sperm by cocultivation with mouse embryo fibroblasts. We found no difference in either the sexual performance or the fertilization efficiency of the sperm between infected and uninfected males.

Nonurban male homosexuals: epidemiologic, immunologic and virologic characteristics

Twenty asymptomatic male homosexuals living in North Carolina were evaluated looking at epidemiologic, immunologic and virologic characteristics. In ten subjects selected for inhalant nitrite use a significantly higher frequency of multiple drug abuse and a trend toward greater sexual promiscuity was found in comparison with ten nonnitrite users. None of the 20 subjects had chronic lymphadenopathy. Cytomegalovirus (CMV) was not found in urine, blood or throat washings, but was found in 29% of the subjects' semen specimens--a finding that was significantly linked (P less than .05) to the presence of CMV IgM antibody in serum. There were no abnormal helper lymphocytes: suppressor T lymphocyte ratios (all greater than 1.3) and lymphocyte mitogen stimulations were not different from heterosexual controls in contrast to frequent abnormalities reported in male homosexuals in metropolitan areas. If these immunologic findings are reproducible, they may be important in understanding why the Acquired Immunodeficiency Syndrome has clustered in large cities.

Seroepidemiology of HTLV-III antibody in Danish homosexual men: prevalence, transmission, and disease outcome

Sera taken from 250 Danish homosexual men in December 1981 as part of a prospective study of the acquired immunodeficiency syndrome (AIDS) were examined for the presence of HTLV-III antibody with an enzyme-linked immunosorbent assay. Antibody was present in 22 (8.8%) of the men. Seropositivity was most strongly associated with sexual exposure to men in the United States (relative risk 3.5; p less than 0.007). Increased frequency of anal receptive intercourse was also independently associated with seropositivity (p less than 0.05), but age, years of homosexual experience, number of homosexual partners, and use of nitrite inhalant were not independent risk factors. The frequency of seroconversion from absence to presence of HTLV-III antibody appeared to be about 1% a month in this community during December 1981 to February 1983. Of the 22 men who were originally seropositive, two (9%) subsequently developed AIDS as defined by the Centre for Disease Control and two (9%) others the AIDS related complex. Blood was taken in addition from two of the men to develop AIDS earliest in Denmark (diagnosed 1981) at the same time as the initial survey in 1981; both were seropositive. The spread of HTLV-III from high to low risk areas and the subsequent appearance of illnesses related to AIDS in the seropositive group support the hypothesis that HTLV-III is causally related to the development of AIDS.

Infection with cytomegalovirus in homosexual men

The prevalence and incidence of cytomegalovirus (CMV) infections were studied in a group of homosexual men. Of the 710 participants, 501 (70.6%) had complement fixing antibodies to CMV on entry to the study. During the follow up (maximum 23 months) 69 CMV infections were found: 50 primary infections among the 209 seronegative men (attack rate 27.3%), and 19 recurrent infections among the 501 seropositive men (attack rate 6.2%). The prevalence of antibody to CMV was correlated with four characteristics of the participants' lifestyles: duration of homosexual activity, number of different sexual partners, history of syphilis, and anal sexual contact. Among the seronegative men, the incidence of primary infection with CMV correlated with a history of syphilis and anal sexual contact. We conclude that infections with CMV are highly prevalent among homosexual men, and that anal sexual contact plays an important part in the transmission of this virus.

Sex habits, recent disease, and drug use in two groups of Danish male homosexuals

Interviewed to obtain the first quantitative data from Scandinavia on lifestyle factors of possible importance for their health were 259 Danish male homosexuals. The frequency of various sex acts, frequency of change in partner, visits to the United States, sexual contacts with victims of the immune suppression syndrome, education, smoking and drug habits, and recent medical problems were recorded. Of those interviewed, 170 were from the Danish capital, Copenhagen, and 89 were from a smaller provincial town, Aarhus. Sexual habits and most other factors were very similar in men from the two cities. Furthermore, the sex habits of those who had visited a venereal disease clinic were similar to those of the group as a whole except for a frequent change of partners. Our data on level of sexual activity resemble those available for the San Francisco Bay area of 1970. The Copenhagen men, however, had more partners per year, had more sexual contact with U.S. citizens and immune suppression syndrome victims, and more had used nitrite inhalation than the men in Aarhus. The frequency of venereal disease was the same in the two groups, but the Danish cases of Kaposi's sarcoma and the acquired immune deficiency syndrome all have come from the Copenhagen area. Two of those interviewed have developed AIDS subsequent to homosexual contact with a case of Kaposi's sarcoma.

Lack of specific cell mediated immunity to cytomegalovirus in people at risk for AIDS

Twenty apparently healthy homosexuals from Italy and five patients with lymphadenopathic syndrome (LAS) were studied for specific cell mediated immunity (CMI) to Cytomegalovirus (CMV), by means of the leukocyte migration inhibition test (LMIT). Total circulating T cells and T cell subpopulations were also investigated by the use of specific monoclonal antibodies of the OK series. An inverted OKT4/T8 ratio was also found in about 30% of subjects. CMV was recovered from the urine of three homosexuals and high specific antibody titers were found in all the people studied. In addition we found a lack of specific CMI to CMV in 18 homosexuals and in 3 patients with LAS. We think that CMV can induce a state of immune tolerance in people at risk for AIDS which may contribute to promote the disease.