Absence of T cell impairments in a unique group of anal-receptive transvestite and male prostitutes in Israel.

High rates of immunologic abnormalities in asymptomatic, clinically healthy urban homosexual men have been associated with promiscuous, unprotected receptive rectal intercourse, and related to infection by the human immunodeficiency virus (HIV), Epstein-Barr virus (EBV) and cytomegalovirus (CMV). In cohort studies in Israel, which is still a low risk country for HIV infection and AIDS, about 40% of asymptomatic, clinically healthy male homosexuals consistently showed T cell defects that were not correlated with anal-receptive sexual behavior and were independent of HIV antibody status. Since pre-existing immune impairments in HIV-seronegative individuals have been implicated as a risk factor for seroconversion, we have attempted to investigate more precisely the role of anal-receptive homosexual activity as a risk factor for the acquisition of immune defects. We compared T lymphocyte profiles and mean geometric titers of EBV and CMV in a homogeneous group of 14 transvestite and male anal-receptive homosexual prostitutes with those of 77 HIV-seronegative male homosexuals who were not exclusively anally passive with multiple sex partners. While 44% of the control group showed a decrease of total T cells or their subpopulations as compared with normal heterosexual men (P less than 0.001), T lymphocyte values of the anal-receptive prostitutes were within the normal range. In the prostitutes, serum antibodies to HIV were detected in only 1 individual, to CMV in 12 of 13, and to EBV in all. Despite high mean geometric titers of antibodies to CMV (86.6) and EBV (25.8), frequent anal-receptive intercourse was not sufficient, in itself, to cause immune impairment in this unique group. The results suggest that the problem of cofactors contributing to immune deficiency in male homosexuals should be reexamined in countries with a low incidence for HIV seropositivity and AIDS.