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Costa ECV, Barbosa T, Soares M, McIntyre T, Pereira MG. Factors Associated with Sexually Transmitted Infections among Users of Voluntary HIV Counseling and Testing Centers in Portugal. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2022; 34:432-449. [PMID: 38596277 PMCID: PMC10903659 DOI: 10.1080/19317611.2022.2032527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 04/11/2024]
Abstract
Objective: Users of publicly funded voluntary HIV Counseling and Testing Centers (VCT C) in the Portuguese National Service have been found to have higher rates of HIV risk behavior than the general population, but data concerning the relationship between socio-demographic, behavioral, and cognitive variables, and Sexually Transmitted Infections (ST Is) in this specific population are limited. This study tests the impact of socio-demographic, behavioral and cognitive variables on ST Is in a sample of 168 users of VCT C. Methods: A cross-sectional study using structured questionnaires was conducted. Results: Being older, being gay or bisexual, and having more barriers towards safer sex (e.g., negative attitudes toward safer sex behavior) were associated with increased odds of having had a ST I diagnosis. We found significant differences between heterosexual and gay men for number of sexual partners, frequency of anal sex, exchanging sex for money or drugs, history of ST Is, AIDS knowledge, and risk beliefs about the partner, with gay men showing higher rates. Conclusions: ST Is education should target older, gay or bisexual individuals, and focus on information as well as on changing barriers towards safer sex and associated health beliefs.
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Affiliation(s)
- Eleonora C. V. Costa
- Faculty of Philosophy and Social Sciences, Centre for Philosophical and Humanistic Studies, Universidade Católica Portuguesa, Braga, Portugal
- North Regional Health Administration, Ministry of Health, Braga, Portugal
| | - Tânia Barbosa
- Faculty of Philosophy and Social Sciences, Centre for Philosophical and Humanistic Studies, Universidade Católica Portuguesa, Braga, Portugal
| | - M. Soares
- North Regional Health Administration, Ministry of Health, Braga, Portugal
| | - Teresa McIntyre
- College of Nursing and Institute for Measurement, Evaluation and Statistics, University of Houston, Houston, TX, USA
| | - M. Graça Pereira
- Applied Psychology Department, School of Psychology, University of Minho, Braga, Portugal
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Hatthakaroon C, Pharkjaksu S, Chongtrakool P, Suwannakarn K, Kiratisin P, Ngamskulrungroj P. Molecular epidemiology of cryptococcal genotype VNIc/ST5 in Siriraj Hospital, Thailand. PLoS One 2017; 12:e0173744. [PMID: 28323835 PMCID: PMC5360237 DOI: 10.1371/journal.pone.0173744] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 02/24/2017] [Indexed: 12/23/2022] Open
Abstract
Despite the strong association between Cryptococcus neoformans infection and the Human immunodeficiency virus (HIV) status of patients globally, most cryptococcosis cases in Far East Asia occur in non-HIV individuals. Molecular epidemiological studies, using multilocus sequence typing (MLST), have shown that more than 95% of cryptococcal strains belong to a specific subtype of VNI. However, this association has never been specifically examined in other parts of Asia. Therefore, in this study, we investigated the VNIc/ST5 genotype distribution among cryptococcosis patients in Thailand. Fifty-one C. neoformans isolates were collected from clinical samples in Siriraj Hospital, Bangkok, Thailand. The strains were predominantly isolated from HIV-positive patients (88.57%) and all were molecular type VNI MATα. An MLST analysis identified five sequence types (ST) in Siriraj Hospital, of which ST4 (45.10%) and ST6 (35.29%) were most common, and ST5 (15.69%), ST32 (1.96%), and ST93 (1.96) were less common. Contrary to reports from Far East Asia, ST5 was predominantly (83.33%) found in HIV patients (P = 0.657), and there was no significant change in the prevalence of ST5 over the past 10 years (P = 0.548). A further analysis of comorbidities showed higher morbidity and delays in the cryptococcal diagnosis in patients with tuberculosis coinfection or without HIV. Our study suggests that although the Thai population is genetically closely related to the Far East Asian population, ST5 is not associated with non-HIV status in Thailand. Therefore, this association may not be related to the host’s genetic background. However, its mechanism remains unclear.
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Affiliation(s)
- Chanin Hatthakaroon
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi, Bangkok, Thailand
| | - Sujiraphong Pharkjaksu
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi, Bangkok, Thailand
| | - Piriyaporn Chongtrakool
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi, Bangkok, Thailand
| | - Kamol Suwannakarn
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi, Bangkok, Thailand
| | - Pattarachai Kiratisin
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi, Bangkok, Thailand
| | - Popchai Ngamskulrungroj
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi, Bangkok, Thailand
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Kaocharoen S, Ngamskulrungroj P, Firacative C, Trilles L, Piyabongkarn D, Banlunara W, Poonwan N, Chaiprasert A, Meyer W, Chindamporn A. Molecular epidemiology reveals genetic diversity amongst isolates of the Cryptococcus neoformans/C. gattii species complex in Thailand. PLoS Negl Trop Dis 2013; 7:e2297. [PMID: 23861989 PMCID: PMC3701708 DOI: 10.1371/journal.pntd.0002297] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 05/23/2013] [Indexed: 12/22/2022] Open
Abstract
To gain a more detailed picture of cryptococcosis in Thailand, a retrospective study of 498 C. neoformans and C. gattii isolates has been conducted. Among these, 386, 83 and 29 strains were from clinical, environmental and veterinary sources, respectively. A total of 485 C. neoformans and 13 C. gattii strains were studied. The majority of the strains (68.9%) were isolated from males (mean age of 37.97 years), 88.5% of C. neoformans and only 37.5% of C. gattii strains were from HIV patients. URA5-RFLP and/or M13 PCR-fingerprinting analysis revealed that the majority of the isolates were C. neoformans molecular type VNI regardless of their sources (94.8%; 94.6% of the clinical, 98.8% of the environmental and 86.2% of the veterinary isolates). In addition, the molecular types VNII (2.4%; 66.7% of the clinical and 33.3% of the veterinary isolates), VNIV (0.2%; 100% environmental isolate), VGI (0.2%; 100% clinical isolate) and VGII (2.4%; 100% clinical isolates) were found less frequently. Multilocus Sequence Type (MLST) analysis using the ISHAM consensus MLST scheme for the C. neoformans/C. gattii species complex identified a total of 20 sequence types (ST) in Thailand combining current and previous data. The Thai isolates are an integrated part of the global cryptococcal population genetic structure, with ST30 for C. gattii and ST82, ST83, ST137, ST141, ST172 and ST173 for C. neoformans being unique to Thailand. Most of the C. gattii isolates were ST7 = VGIIb, which is identical to the less virulent minor Vancouver island outbreak genotype, indicating Thailand as a stepping stone in the global spread of this outbreak strain. The current study revealed a greater genetic diversity and a wider range of major molecular types being present amongst Thai cryptococcal isolates than previously reported.
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Affiliation(s)
- Sirada Kaocharoen
- Mycology Laboratory, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Molecular Mycology Research Laboratory, CIDM, Sydney Medical School - Westmead Hospital, The University of Sydney, Westmead Millennium Institute, Westmead, New South Wales, Australia
| | - Popchai Ngamskulrungroj
- Molecular Mycology Research Laboratory, CIDM, Sydney Medical School - Westmead Hospital, The University of Sydney, Westmead Millennium Institute, Westmead, New South Wales, Australia
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Carolina Firacative
- Molecular Mycology Research Laboratory, CIDM, Sydney Medical School - Westmead Hospital, The University of Sydney, Westmead Millennium Institute, Westmead, New South Wales, Australia
- Grupo de Microbiología, Instituto Nacional de Salud, Bogotá, Colombia
| | - Luciana Trilles
- Molecular Mycology Research Laboratory, CIDM, Sydney Medical School - Westmead Hospital, The University of Sydney, Westmead Millennium Institute, Westmead, New South Wales, Australia
- Laboratório de Micologia, Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Dumrongdej Piyabongkarn
- Mycology Laboratory, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Wijit Banlunara
- Department of Pathology, Faculty of Veterinary Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Natteewan Poonwan
- Mycology Laboratory, National Institute of Health, Nonthaburi, Thailand
| | - Angkana Chaiprasert
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wieland Meyer
- Molecular Mycology Research Laboratory, CIDM, Sydney Medical School - Westmead Hospital, The University of Sydney, Westmead Millennium Institute, Westmead, New South Wales, Australia
| | - Ariya Chindamporn
- Mycology Laboratory, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- * E-mail:
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Akinwande OA, Ele PU, Gebi UI, Igboelina DO, Dakum PS, Alkan ML. Demographic predictors of HIV serostatus among HIV counseling and testing clients in rural Nigeria. ACTA ACUST UNITED AC 2012; 11:366-8. [PMID: 22875580 DOI: 10.1177/1545109712454193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Nnewi is a rural Nigerian town with a human immunodeficiency virus (HIV) counseling and testing center which tests about 120 clients/d. The objective of this study is to determine the factors predicting positive HIV status at Nnewi. Review of records was done with age, gender, marital status, and occupation as variables. Logistic regression analysis was used to identify factors linked to a positive HIV test. Overall HIV prevalence was 31.14%. Drivers and married clients had a high risk of being HIV+ (odds ratio [OR], 3.59; 95% confidence interval [CI], 2.17-5.96 and OR, 2.78; 95% CI, 2.42-3.19). Housewives were 2 times more likely to be positive (OR, 2.11; 95% CI, 1.35-3.29). After adjustment, females had 22% higher risk (OR, 1.22; 95% CI, 1.03-1.45) with the highest chance found in married females (OR, 6.70; 95% CI, 4.45-10.09). The study succeeded in panning out an unexpected risk group: married women. Drivers have been known to be a risk group. Preventive methods must be tailored to and acceptable by each risk group.
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Rungsiyanont S, Vacharotayangul P, Lam-Ubol A, Ananworanich J, Phanuphak P, Phanuphak N. Perceived dental needs and attitudes toward dental treatments in HIV-infected Thais. AIDS Care 2012; 24:1584-90. [PMID: 22428899 DOI: 10.1080/09540121.2012.663884] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Despite the advancement in highly active antiretroviral therapy and improved health status of HIV-infected individuals, dental problems are still affecting their life and well-beings. We aimed to establish the prevalence of oral and dental complaints among HIV-infected patients, the prevalence of delayed access to dental service, and factors related with delayed access to dental service. A cross-sectional study using self-report questionnaire completed by the HIV-positive subjects was conducted at the largest HIV research clinic in Thailand during 2009-2010. Of all 299 subjects (28.6% males, 71% females, and 0.4% sex change from male to female: ages ranged from 22 to 59 years [mean 36.7±5.53)]), 84.3% reported of having past or present illnesses or problems related to the dental or oral conditions. The most reported problems were dental hypersensitivity (93.3%), bleeding from the gum (92.1%), and having dental caries (65.9%). Two-hundred and forty-two subjects (80.9%) would not disclose their HIV status when seeing a dentist. The most cited reasons of such behavior were their personal right whether to reveal or not, and being afraid of not receiving dental treatment from the dentists or staffs (51.7 and 40.9%, respectively). It is important to note that HIV-subjects admitted to having fear of being discriminated by the dental staffs even if they trusted their dentists as having high morality. In conclusion, our HIV-subjects had good basic knowledge of oral health with regard to HIV infection, experienced common dental problems, and wished to have accesses to HIV-dental specialist services, if possible.
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Affiliation(s)
- Sorasun Rungsiyanont
- Department of Oral Surgery and Oral Medicine, Faculty of Dentistry, Srinakharinwirot University, Wattana, Bangkok, Thailand.
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Khongphatthanayothin M, Avihingsanon A, Teeratakulpisarn N, Phanuphak N, Buajoom R, Suwanmala P, Phanuphak P. Feasibility and efficacy of isoniazid prophylaxis for latent tuberculosis in HIV-infected clients patients in Thailand. AIDS Res Hum Retroviruses 2012; 28:270-5. [PMID: 21899431 DOI: 10.1089/aid.2011.0041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A prospective study was conducted in 4339 HIV-positive clients at the Thai Red Cross AIDS Research Centre (TRC-ARC) Anonymous clinic, Bangkok, Thailand between January 2003 and April 2008. A tuberculin skin test (TST) was done for all patients without a previous history of tuberculosis (TB). Nine months of isoniazid (INH) was given for all positive TST/no active TB. TST-negative clients were asked to repeat the TST annually. The study aim was to evaluate the feasibility and efficacy of INH prophylaxis for preventing TB in HIV-positive Thai patients. Of those patients, 4111 (94.7%) had a TST done; 1157 (28.1%) were TST positive and 799 patients started INH prophylaxis. In all, 551 (69%) and 633 (79.2%) patients completed 9 months and 6 months of INH, respectively; 176 (20.2%) patients had a negative TST at baseline and subsequently converted to positive. Only patients with a baseline CD4 >200 cells/μL (p=0.000) and currently on antiretroviral (ARV) treatment (p=0.000) were related to having a positive TST. This baseline CD4 level was also significantly related to higher INH completion rates at 6 months (p=0.000). Interestingly, none of INH completion patients developed active TB. The feasibility of INH prophylaxis in TST-positive patients in this setting is possible. However, the long-term advantage of INH prophylaxis in terms of TB prevention, especially in HIV-1-infected patients on highly active antiretroviral therapy (HAART), is still an issue that needs more research.
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Affiliation(s)
| | - Anchalee Avihingsanon
- HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Bangkok, Thailand
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Nittaya Phanuphak
- Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- South East Asia Research Collaboration with Hawaii (SEARCH), Bangkok, Thailand
| | | | | | - Praphan Phanuphak
- Thai Red Cross AIDS Research Centre, Bangkok, Thailand
- HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), Bangkok, Thailand
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Acceptability of male circumcision for the prevention of HIV among high-risk heterosexual men in Thailand. Sex Transm Dis 2010; 37:352-5. [PMID: 20145588 DOI: 10.1097/olq.0b013e3181c9963a] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Limited data are available on circumcision prevalence and acceptability among Thai men to prevent human immunodeficiency virus. Of 408 high-risk heterosexual men, 12.3% were circumcised. 14.2% and 24.9% expressed willingness to be circumcised before and after circumcision education, respectively. Neonatal circumcision acceptability was relatively high. One participant underwent circumcision at 3-month follow-up.
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Horyniak D, Guy R, Prybylski D, Hellard M, Kaldor J. The utility of voluntary counselling and testing data as a source of information on HIV prevalence: a systematic review. Int J STD AIDS 2010; 21:305-11. [DOI: 10.1258/ijsa.2009.009427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We explored the utility of routine HIV testing data from clinical services for estimating HIV prevalence. A systematic review identified 28 eligible publications, covering concentrated epidemics (16 of 28) and generalized epidemics (12). Of the 16 papers from concentrated epidemics, five presented estimates by risk group and four by testing history with a median HIV prevalence of 1.8% in first-time testers compared with 3% in repeat testers. Two reports from generalized epidemics restricted estimates to asymptomatic clients and three included breakdowns by reason-for-test, with the median HIV prevalence higher in symptomatic clients (62%) than others (24%). Two papers from generalized epidemics showed prevalence estimates based on routine HIV testing data were slightly higher than estimates derived from other surveillance methods, but did not restrict estimates to asymptomatic patients. We conclude that routine HIV testing data may be a supplementary data source for HIV surveillance provided careful analyses are conducted.
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Affiliation(s)
- D Horyniak
- Centre for Population Health, Macfarlane Burnet Institute for Medical Research and Public Health, 85 Commercial Rd, Melbourne VIC 3004
| | - R Guy
- Centre for Population Health, Macfarlane Burnet Institute for Medical Research and Public Health, 85 Commercial Rd, Melbourne VIC 3004
- National Centre in HIV Epidemiology and Clinical Research (NCHECR), University of New South Wales, 45 Beach St, Coogee, NSW, Australia
| | - D Prybylski
- Family Health International, Asia-Pacific Regional Office, 130-132 Sindhorn Bldg, 19th Floor, Bangkok, Thailand
| | - M Hellard
- Centre for Population Health, Macfarlane Burnet Institute for Medical Research and Public Health, 85 Commercial Rd, Melbourne VIC 3004
| | - J Kaldor
- National Centre in HIV Epidemiology and Clinical Research (NCHECR), University of New South Wales, 45 Beach St, Coogee, NSW, Australia
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Arroyo MA, Phanuphak N, Krasaesub S, Sirivichayakul S, Assawadarachai V, Poltavee K, Pankam T, Ananworanich J, Paris R, Tovanabutra S, Kijak GH, McCutchan FE, Phanuphak P, Kim JH, de Souza M. HIV type 1 molecular epidemiology among high-risk clients attending the Thai Red Cross Anonymous Clinic in Bangkok, Thailand. AIDS Res Hum Retroviruses 2010; 26:5-12. [PMID: 20055593 DOI: 10.1089/aid.2009.0150] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Several studies have reported an increasing number of non-CRF01_AE infections in high-risk groups in Thailand suggesting a more complex HIV-1 epidemic. This study assessed the complexity of the HIV epidemic among high-risk clients tested for HIV-1 at the Thai Red Cross Anonymous Clinic (TRCAC) between July 1, 2006 and February 28, 2007. HIV-1 genotypes were determined from plasma of infected subjects (n = 401) by the multiregion hybridization assay (MHAbce, v.2). Univariate and multivariate logistic regression analyses were used to determine risk factors associated with HIV prevalence and non-CRF01_AE infection. The estimated overall HIV prevalence was 14.1%: 25.3% among men who have sex with men (MSM), 18.4% among heterosexual women, and 9.6% among heterosexual men. Among the risk factors found to be associated with HIV prevalence were age (25-29 years), risk behavior (MSM), marital status (not single), education (less than high school), and inconsistent condom use. Overall, non-CRF01_AE strains accounted for 18.9% of the infections: 25.3% among MSM and 14.8% and 20.4% among heterosexual women and men, respectively. Our results indicate a concentrated and genetically complex HIV epidemic among Thai MSM. These findings advocate for targeted intervention and prevention measures among high-risk populations in Thailand.
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Affiliation(s)
- Miguel A. Arroyo
- Department of Retrovirology, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand 10400
| | | | - Somporn Krasaesub
- Department of Retrovirology, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand 10400
| | | | - Vatcharain Assawadarachai
- Department of Retrovirology, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand 10400
| | - Kultida Poltavee
- Department of Retrovirology, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand 10400
| | - Tippawan Pankam
- The Thai Red Cross AIDS Research Centre, Bangkok, Thailand 10330
| | - Jintanat Ananworanich
- South East Asia Research Collaboration with Hawaii (SEARCH), Bangkok, Thailand 10330
| | - Robert Paris
- Department of Retrovirology, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand 10400
| | - Sodsai Tovanabutra
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, Maryland 20850
| | - Gustavo H. Kijak
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, Maryland 20850
| | - Francine E. McCutchan
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, Maryland 20850
- Bill & Melinda Gates Foundation, Seattle, Washington 98102
| | | | - Jerome H. Kim
- Division of Retrovirology, Walter Reed Army Institute of Research/U.S. Military HIV Research Program (MHRP), Rockville, Maryland 20850
| | - Mark de Souza
- Department of Retrovirology, Armed Forces Research Institute of Medical Sciences (AFRIMS), Bangkok, Thailand 10400
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Incidence and characterization of acute HIV-1 infection in a high-risk Thai population. J Acquir Immune Defic Syndr 2008; 49:151-5. [PMID: 18769355 DOI: 10.1097/qai.0b013e318183a96d] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The objective of this study was to investigate the incidence, demographics, HIV subtype, and genotypic resistance of acute HIV infections in a high-risk Thai population. METHODS Between March 2006 and September 2007, 6426 stored samples at the Thai Red Cross Anonymous Clinic were screened for acute HIV infection by 2 methods: pooled nucleic acid testing (NAT) of fourth-generation enzyme immunoassay (EIA)-negative samples (n = 5402) and subsequent first-generation EIA testing of fourth-generation EIA-positive samples (n = 1024). RESULTS Eleven acute HIV-infected subjects were identified by pooled NAT (n = 7) and serial EIA (n = 4). Mean age was 28 years; 9 were male; and 60% were men who have sex with men. Median HIV RNA was 99,601 copies per milliliter (log10 viral load (VL) = 5.00). Eight samples could be genotyped: 6, CRF01_AE; 1, subtype B; and 1, CRF01_AE/B recombinant. No resistance to antiretroviral therapy was found. The HIV incidence per 100 person-years, calculated from the pooled, antibody-negative samples, was 2.7% (95% confidence interval, 2.2%-4.3%). CONCLUSIONS This is the first report of antibody-negative, NAT-positive, acute HIV infection in Thailand. The majority were men who have sex with men, which reflects the current epidemic in Thailand and justifies prevention programs aimed at this group. This high-risk population may be suitable for future studies on acute HIV infection, HIV treatment, vaccine, and prevention of onward transmission strategies.
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Bradley H, Bedada A, Tsui A, Brahmbhatt H, Gillespie D, Kidanu A. HIV and family planning service integration and voluntary HIV counselling and testing client composition in Ethiopia. AIDS Care 2008; 20:61-71. [DOI: 10.1080/09540120701449112] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- H. Bradley
- a Department of Population, Family and Reproductive Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , US
| | - A. Bedada
- b Family Guidance Association of Ethiopia , Addis Ababa , Ethiopia
| | - A. Tsui
- a Department of Population, Family and Reproductive Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , US
| | - H. Brahmbhatt
- a Department of Population, Family and Reproductive Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , US
| | - D. Gillespie
- a Department of Population, Family and Reproductive Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , US
| | - A. Kidanu
- c Miz-Hasab Research Center , Addis Ababa , Ethiopia
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Sirivichayakul S, Phanuphak P, Pankam T, O-Charoen R, Sutherland D, Ruxrungtham K. HIV drug resistance transmission threshold survey in Bangkok, Thailand. Antivir Ther 2008. [DOI: 10.1177/135965350801302s14] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Antiretroviral therapy (ART) began in Thailand in the Bangkok Metropolitan Area (BMA) in 1988 and scale-up began in 2001. The national first-line regimen is stavudine, lamivudine and nevirapine in fixed-dose combination, which is a regimen with a low genetic barrier for resistance. Because viral load and resistance testing are not widely available, unidentified HIV drug resistance (HIVDR) may occur during treatment and could be transmitted. Methods We undertook a threshold survey to assess HIVDR transmission in two subsets of recently infected individuals in the BMA. The first group consisted of returning blood donors tested at the Thai Red Cross National Blood Centre who seroconverted within the past 12 months. The second group comprised recently infected (as defined by BED assay) clients of the Thai Red Cross voluntary counselling and testing centre (VCT). Results Genotyping of 50 consecutive specimens each from blood donors and VCT clients during 2005–2006 showed no mutations associated with HIVDR in the reverse transcriptase or protease regions of the HIV pol gene. These results are categorized by the WHO HIV drug resistance threshold survey method as representing a low prevalence (<5%) of transmitted HIV drug resistance. Conclusions Every effort should be made to minimize the emergence of resistance in treated individuals and to prevent primary and secondary HIV transmission. To continue to monitor HIVDR transmission, Thailand has planned additional surveys – including longitudinal surveys – in these and additional groups of individuals.
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Affiliation(s)
- Sunee Sirivichayakul
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | | | | | | | - Kiat Ruxrungtham
- Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Krishnan S, Dunbar MS, Minnis AM, Medlin CA, Gerdts CE, Padian NS. Poverty, gender inequities, and women's risk of human immunodeficiency virus/AIDS. Ann N Y Acad Sci 2007; 1136:101-10. [PMID: 17954681 DOI: 10.1196/annals.1425.013] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Entrenched economic and gender inequities together are driving a globally expanding, increasingly female, human immunodeficiency virus (HIV)/AIDS epidemic. To date, significant population-level declines in HIV transmission have not been observed, at least in part because most approaches to prevention have presumed a degree of individual control in decision making that does not speak to the reality of women's and girls' circumstances in many parts of the world. Such efforts have paid insufficient attention to critical characteristics of the risk environment, most notably poverty and gender power inequities. Even fewer interventions have addressed specific mechanisms through which these inequities engender risky sexual practices that result in women's disproportionately increased vulnerabilities to HIV infection. This article focuses on identifying those mechanisms, or structural pathways, that stem from the interactions between poverty and entrenched gender inequities and recommending strategies to address and potentially modify those pathways. We highlight four such structural pathways to HIV risk, all of which could be transformed: (1) lack of access to critical information and health services for HIV/sexually transmitted infection (STI) prevention, (2) limited access to formal education and skill development, (3) intimate partner violence, and (4) the negative consequences of migration prompted by insufficient economic resources. We argue for interventions that enhance women's access to education, training, employment, and HIV/STI prevention information and tools; minimize migration; and by working with men and communities, at the same time reduce women's poverty and promote gender-equitable norms. In conclusion, we identify challenges in developing and evaluating strategies to address these structural pathways.
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Affiliation(s)
- Suneeta Krishnan
- Women's Global Health Imperative, Research Triangle Institute International, 114 Sansome St., Suite 500, San Francisco, CA 94104, USA.
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