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Development of an effective HIV-1 vaccine will be facilitated by better understanding the dynamics between the founder virus and the early humoral responses. Variations between subtypes may influence the evolution of immune responses and should be considered as we strive to understand these dynamics.

Background In Thailand, HIV transmission is well characterized in large urban centers such as Bangkok and Chiang Mai but less so outside of these areas. We assessed HIV incidence and associated risk factors in two other locations. Methods Participants assigned male sex at birth were enrolled in Nakhon Ratchasima and Ratchaburi. HIV and syphilis testing and sociobehavioral questionnaires occurred over 18 months. HIV incidence rates and 95% confidence intervals (CIs) were estimated using a Poisson distribution. Cox proportional hazards models were used to estimate unadjusted and adjusted hazard ratios (aHRs) and 95% CIs for associations between potential risk factors and HIV seroconversion. Results A total of 1003 participants were enrolled. Overall HIV incidence was 1.56 per 100 person-years (95% CI:1.02–2.44) and similar at both sites. In the fully adjusted model, receptive anal sex in the past 6 months was associated with seroconversion (aHR:3.05, 95% CI:1.00-9.32), while sex with a sex worker in the past six months was associated with reduced risk of seroconversion (aHR:0.11, 95% CI:0.01–0.80). In the parsimoniously adjusted model, receptive anal sex (aHR:3.35, 95% CI:1.30–8.63) and STI diagnosis in the past six months (aHR:3.39, 95% CI:1.11–10.29) were associated with seroconversion, while sex with a sex worker in the past six months was associated with reduced risk of seroconversion (aHR:0.12, 95% CI:0.02–0.70). Conclusions Recent receptive anal sex practices were associated with HIV acquisition in these populations, highlighting the continued need for interventions encouraging safer anal sex practices to reduce HIV incidence.

Background Routine screening for HIV and other sexually transmitted infections (STIs) facilitates early diagnosis and treatment, thereby preventing morbidity and onward transmission. We estimated the prevalence of prior HIV/STI testing among men who have sex with men (MSM) and transgender women (TGW) in Bangkok, Thailand, and identified factors associated with prior testing. Methods Cross-sectional analyses were performed using data collected at enrollment into an HIV incidence cohort. From April to October 2017, MSM and TGW were enrolled if they were aged 18–35 years, reported anal intercourse with a male or TGW partner, and reported behavioral vulnerability to HIV. Participants answered questions about demographics, sexual behaviors, and lifetime HIV/STI testing history. Multivariable robust Poisson regression was used to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for factors potentially associated with prior testing. Results Among 1,014 participants, 348 (34.3%) were TGW and the median age was 21.6 (interquartile range 20.0-24.8) years. Prior testing for HIV was reported by 421 (41.5%) and for other STIs by 268 (26.4%). HIV testing was more common among participants aged ≥ 22 years (RR 1.37 [95% CI 1.13–1.67]), with college education as compared to secondary or less (RR 1.37 [95% CI 1.08–1.72]), and who met male sexual partners online (RR 1.52 [95% CI 1.24–1.85]), but lower among participants attracted to both men and women as compared to men only (RR 0.64 [95% CI 0.51–0.81]) and who met male sexual partners in bars (RR 0.83 [95% CI 0.72–0.97]). Similar associations were observed with prior testing for other STIs, including increased testing among participants with college education (RR 1.52 [95% CI 1.11–2.09]) and who met male sexual partners online (RR 1.73 [95% CI 1.30–2.31]), but lower among participants attracted to both men and women (RR 0.70 [95% CI 0.51–0.96]) and who met male sexual partners in bars (RR 0.67 [95% CI 0.54–0.83]). Conclusions Despite behavioral vulnerability, prior testing for HIV and other STIs was uncommon. Online engagement strategies may be effectively reaching Thai MSM and TGW who meet sexual partners online, but new interventions are needed to encourage testing among younger, less educated, and bisexual MSM and TGW.

Background: In order to assess feasibility for future HIV prevention trials, we measured HIV incidence, retention, and assessed risk factors for seroconversion among men who have sex with men (MSM) and transgender women (TGW) in Bangkok, Thailand between 2017-2019. Methods: We conducted an 18-month prospective cohort study of HIV-uninfected Thai cisgender men and transgender women who reported sex with men in the past six months. HIV and syphilis testing and computer-based behavioral questionnaires were administered at each visit. We utilized Poisson regression to calculate HIV incidence rates. A survival random forest model identified the most predictive risk factors for HIV seroconversion and then used in a survival regression tree model to elucidate hazard ratios for individuals with groups of selected risk factors. Cox proportional hazards (PH) regression evaluated the strength of association between individual covariates and risk of seroconversion. Findings: From April 2017-October 2019, 1,184 participants were screened, 167 were found ineligible, and 1,017 enrolled. Over the 18-month study, visit retention was 93·4% (95% CI 91·6%-94·8%) and HIV incidence was 3·73 per 100 person-years (95% CI 2·79-5·87). Utilizing survival regression tree modeling, those who were 18-20 years of age, reported sexual attraction to mostly or only men, and had five or more lifetime sexual partners were 4·9 times more likely to seroconvert compared to other cohort participants. Factors associated with HIV incidence utilizing Cox PH regression included sexual attraction to mostly or only men (adjusted hazard ratio (aHR) 14·9 (95% CI 20·1-107·9), younger age (18-19 years, aHR 10·88 (95% CI 4·12-28·7), five or greater lifetime sexual partners (aHR 2·0, 95%CI 1·1-3·6), inconsistent condom use with casual partners (aHR 2·43, 95% CI 1·3-4·5), and prior HIV testing (adjusted HR 2·0, 95% CI 1·1-3·5). Interpretation: HIV incidence remains high among Bangkok-based MSM and TGW. These key populations have high retention and are ideal candidates for efficacy evaluation of future prevention strategies. Funding Statement: This work was supported by the US Army Medical Research and Materiel Command (Military Infectious Diseases Research Program) (cooperative agreements W81XWH-11-2-0174 and W81XWH-07-2-0067 with the Henry M. Jackson Foundation for the Advancement of Military Medicine), the US Army Medical Materiel Development Activity, and the National Institute of Allergy and Infectious Disease (interagency agreement Y1-AI-2642-12 with the US Army Medical Research and Materiel Command) and the Division of AIDS Interagency Agreements (DAIDS IAA Y1-AI-2642-16). Declaration of Interests: T.C. reports grants from U.S. Army, grants from NIH, M.R. and S.V. reports grants from US Army Medical Research and Materiel Command with Henry M. Jackson Foundation for the Advancement of Military Medicine, during the conduct of the study. All other authors report no potential conflicts. Ethics Approval Statement: The study was reviewed and approved by the institutional review boards at Walter Reed Army Institute of Research (WRAIR), Faculty of Tropical Medicine at Mahidol University, and the Royal Thai Army. All participants provided written informed consent prior to enrollment.

As part of routine surveillance, an HIV-1 serosurvey of 366,074 members of successive cohorts of young Thai men entering service with the Royal Thai Army (RTA) was conducted between November 1989 and November 1995. We analyzed regional and temporal trends in HIV-1 seroprevalence in young men in Thailand and determined the proportion of infections resulting from subtypes E and B in this population in 1992 and 1995. The prevalence in 1992 was compared with that in 1995 by region and demographic group. The HIV-1 subtype was determined in a random sample of HIV-1-positive specimens in 1992 and 1995 using a V3 peptide enzyme immunoassay. From a peak of 3.7% in 1993, overall seroprevalence declined to 3.0% in 1994 and further in 1995 to 2.5%. Between 1992 and 1995, the absolute decrease in seroprevalence was greatest in the upper North (from 12.5% to 5.3%), where the prevalence has been the highest. Overall, 96.9% and 95.9% of typable specimens were determined to be subtype E in 1992 and 1995, respectively. Decline in HIV-1 seroprevalence among young men in Thailand has continued, which suggests that HIV control programs in Thailand may have been successful in decreasing spread of HIV-1. Almost all HIV-1 infections resulted from subtype E.

An anonymous, self-administered behavioral survey was conducted in Royal Thai Army (RTA) conscripts from 19 provinces throughout Thailand in May 1996. All (to a maximum of 350) Thai men who entered the RTA in each province were selected. Data from 5474 men were included in this analysis. High-risk behaviors were reported nationwide; however, some regional differences were found. Men from the upper North were more likely to have had a commercial sex worker (CSW) as their first sexual partner (42%) than men from any other region. However, in the past year, reported sex with CSWs in the upper North (41%) was similar to or lower than those in other regions. Consistent condom use with CSWs was higher in the North than in any other region. Condom use at first sex with CSWs increased with later years at first sex in all regions. These data suggest that past higher-risk behavior among young men in the upper northern part of Thailand may have contributed to the concentration of the HIV epidemic in that region. Risk behaviors, particularly unprotected sex, appear to be decreasing nationwide.The HIV behavioral risk factors associated with temporal and regional trends in HIV prevalence were investigated in a 1996 survey of 5474 Royal Thai Army conscripts from 19 provinces. 89% of respondents were 21 years of age and 77% were single. HIV prevalence was highest among men from the upper north (4.3%), followed by 2.6% in the central region, 2.4% in Bangkok, and 1.2% in the southeast. The median age at first intercourse was 17 years. Among sexually experienced men, a significantly higher proportion of those from the upper north (42%) had their first such encounter with a commercial sex worker (CSW). However, sex with CSWs during the year preceding the survey was similar or less frequent among men from the upper north (41%) compared with other regions. Also, significantly more men from the upper north (62%) used condoms every time with a CSW. Overall, 10% (range, 8-12%) reported having had sex with a man and 13% reported symptoms of a sexually transmitted disease (STD). Men whose sexual initiation occurred after 1990 were more likely to use condoms with a CSW partner. The decrease in sexual risk factors documented in this survey is consistent with national declines in HIV prevalence, especially in the upper northern region, after 1992. The increase in condom use with CSWs coincides with the 100% condom campaign initiated in 1991, intensified STD control efforts, and the emergence of AIDS deaths. Sex with non-CSW female partners, where condoms are rarely used, and homosexual sex require attention as situations where HIV risk may persist.

Deficiencies in antioxidants contribute to immune dysregulation and viral replication. To evaluate the correlation of selenium (Se) and zinc (Zn) levels on the treatment outcomes in HIV-infected children.HIV-infected Thai children 1-12 years old, CD4 15-24%, without severe HIV symptoms were included. Se and Zn levels were measured by graphite furnace atomic absorption spectrometry at baseline and 48 weeks. Deficiency cutoffs were Se0.1 μmol/l and Zn9.9 μmol/l. Serum ferritin and C-reactive protein (CRP) were measured every 24 weeks. No micronutrient supplement was prescribed.In all, 141 children (38.3% male) with a median (interquartile range (IQR)) age of 7.3 (4.2-9.0) years were enrolled. Median baseline CD4% was 20%, HIV-RNA was 4.6 log(10)copies/ml. At baseline, median (IQR) Se and Zn levels were 0.9 (0.7-1.0) μmol/l and 5.9 (4.8-6.9) μmol/l, respectively. None had Se deficiency while all had Zn deficiency. Over 48 weeks, 97 initiated antiretroviral therapy (ART) and 81% achieved HIV-RNA50 copies/ml with 11% median CD4 gain. The mean change of Se was 0.06 μmol/l (P=0.003) and Zn was 0.42 μmol/l (P=0.003), respectively. By multivariate analysis in children who received ART, predictors for greater increase of CD4% from baseline were lower baseline CD4% (P0.01) and higher baseline Zn level (P=0.02). The predictors for greater decrease of HIV-RNA from baseline were higher baseline HIV-RNA and higher ferritin (both P0.01). No association of CRP with the changes from baseline of CD4% or HIV-RNA was found.In HIV-infected Thai children without severe immune deficiency who commenced ART, no correlation between Se and ART treatment outcomes was found. Higher pre-ART Zn levels were associated with significant increases in CD4% at 48 weeks.

To determine health related quality of life (QoL) of patients diagnosed with cervical intraepithelial neoplasia (CIN) and cervical cancer compared QoL among stages of cancer and to study the association between QoL and patients' characteristics.The questionnaire elicited information and QoL using Functional Assessment of Cancer Therapy General (FACT-G) questionnaire. The study population was patients with a diagnosis of one of the four FIGO stages of cervical cancerOne hundred seventy two patients completed the present study. The adjusted mean scores QoL was 78.76. There were no significant differences between FIGO stages on the global QoL and subscale. The authors found negative association between age and physical wellbeing scores (p = 0.049) and a positive association between age and emotional wellbeing scores (p = 0.004). Lower educational attainment was associated with higher emotional wellbeing scores (p = 0.004).For many patients, family, religion, or psycho-social support may be considered a necessity. The younger and better-educated groups may require more information and psycho-emotional support.