Chronic hepatitis B and C co-infection increased all-cause mortality in HAART-naive HIV patients in Northern Thailand.

A total of 755 highly active antiretroviral therapy (HAART)-naive HIV-infected patients were enrolled at a government hospital in Thailand from 1 June 2000 to 15 October 2002. Census dateo f survival was on 31 October 2004 or the date of HAART initiation. Of 700 (92.6%) patients with complete data, the prevalence of hepatitis B virus (HBV) surface antigen and anti-hepatitis C virus (HCV) antibody positivity was 11.9% and 3.3%, respectively. Eight (9.6%) HBV co-infected patients did not have anti-HBV core antibody (anti-HBcAb). During 1166.7 person-years of observation (pyo), 258 (36.9%) patients died [22.1/100 pyo, 95% confidence interval (CI) 16.7­27.8]. HBV and probably HCV co-infection was associated with a higher mortality with adjusted hazard ratios (aHRs) of 1.81 (95% CI 1.30­2.53) and 1.90 (95% CI0.98­3.69), respectively. Interestingly, HBV co-infection without anti-HBc Ab was strongly associated with death (aHR 6.34, 95% CI 3.99­10.3). The influence of hepatitis co-infection on the natural history of HAART-naive HIV patients requires greater attention.

Variable sequences in the long terminal repeat and Its downstream region of some of HIV Type 1 CRF01_AE recently distributing among Thai carriers.

Human immunodeficiency virus type 1 (HIV-1) proviral DNA sequences in and downstream of the 5' long terminal repeat (LTR) were compared among samples obtained from 13 HIV-1 CRF01_AE-infected individuals in Thailand from 1998 to 1999. Eleven individuals had highly conserved sequences compared with previously reported CRF01_AE viruses. However, T cell-specific factor (TCF)-1alpha motif, which is located just beside the 3' terminus of the nef sequence, was duplicated in 2 out of the 13 subjects, one of whom had also lost the 24 nucleotides next to the 3' of the primer-binding site. Thus, several characteristics of CRF01_AE LTR and gag-leader sequence were identified in some samples recently obtained in Thailand.

Full-length sequences of two CRF01_ae (subtype e) HIV type 1 isolates from 1995 samples of patients with sexually transmitted diseases in Thailand.

We isolated two CRF01_AE human immunodeficiency virus type 1 (95TNIH022 and 95TNIH047) from the 1995 blood samples derived from asymptomatic carriers in Ubonratchatani province of northeastern Thailand. Both isolates can replicate in peripheral blood mononuclear cells, but not in several T cell lines examined. The full-length sequences recovered from proviruses in infected cells by long-range polymerase chain reaction were determined. Phylogenetic analyses of these sequences at individual genes showed them to be closely related to those of reported CRF01_AE HIV-1, such as 1990 isolate CM240 and 1993 isolate 93TH253. Two isolates in this study also showed a similar pattern of CRF01_AE mosaicism and a similar structure at the long terminal repeat, i.e., a copy number of NF-kappaB binding sites, sequence at the TATA box, and the putative secondary structure of stem-loop in the transactivation response region. Our results showed that 1995 Thai E isolates could contribute to our understanding of the epidemiology, pathogenesis, and diagnostics of HIV-1 CRF01_AE and further to vaccine development.

Low or no antibody responses to human immunodeficiency virus type 1 Nef in infected carriers with subtype E, in contrast to subtype B that showed antibodies preferentially recognizing subtype-specific Nef epitopes.

The viral accessory gene product Nef has been shown to play an important role in human immunodeficiency virus type 1 (HIV-1)-induced pathogenesis. Only little information is available regarding the differences in the host immune responses against Nef protein and its function in vivo among different subtypes of HIV-1. In the present study, we showed marked differences in the immune responses to Nef protein between subtypes B and E. The amino acid sequence in subtype E Nef showed 72% homology with that in subtype B. Most murine monoclonal antibodies obtained by immunization with subtype B or E Nef protein showed cross-reactivity with both Nef proteins (80 and 67%, respectively). Next, we focused on the immune responses among infected Japanese and Thai individuals. Subtyping of the individuals into B and E was carried out by enzyme-linked immunosorbent assay (ELISA) using synthetic peptides corresponding to the V3 loop representing the principal neutralizing domain. Most of the sera from these individuals reacted strongly with Gag p24 proteins derived from subtypes B and E at similar levels. However, the immune responses among these individuals to Nef protein were markedly different. Some subtype B-infected Japanese and Thai individuals (40 and 35%, respectively) showed higher levels of anti-Nef antibodies, although these antibodies preferentially recognized epitopes specific to subtype B. On the other hand, most of the subtype E-infected Japanese and Thai individuals showed low or no antibody responses to Nef proteins. Thus, immune responses to Nef were markedly different between subtypes B- and E-infected carriers, suggesting different function(s) for Nef in AIDS pathogenesis. Further, vaccine design must take into account the different subtypes of HIV-1.

Highly variable sequences in the env V3 region of HIV type 1 distributing among Thai carriers from 1995 to 1997.

The amino acid sequences of the Env V3 region of HIV-1 subtype E in Thailand were highly variable in the samples obtained from 1995 to 1997, compared with the previously reported sequences in samples obtained from 1990 to 1993. The sequences of the V3 region in the samples from five provinces in Thailand revealed that the variability was much higher in the samples from Bangkok and Ubonrachathani than in those from Chiangmai, Prathumthani, and Trang. There was no apparently different level of diversity at the V3 region in the samples from symptomatic and asymptomatic individuals. The V3 loop motif in most (66.7%) of the samples was GPGQ, although this motif was more heterogeneous in the samples from Bangkok and Ubonrachathani than in those from the other three provinces. The N-linked glycosylation sites in the V3 region among these samples were relatively conserved. There was no apparent difference in the presence of positively charged amino acids at positions 306 and 320 between the samples from symptomatic and asymptomatic individuals.

The association of skin diseases with human herpesvirus 8 infection in HIV carriers.

The seroprevalence to Kaposi's sarcoma-associated herpesvirus (KSHV) or human herpesvirus type 8 (HHV-8) was surveyed in human immunodeficiency virus type 1 (HIV-1) carriers with or without skin diseases, and also in HIV-1 negative individuals in Thailand. Using an immunofluorescence assay, the seropositive rates to lytic antigens of HHV-8 in HIV-1 carriers with or without skin diseases were 25% and 7.4%, respectively, but none of HIV-1 negative individuals had antibody. The seroprevalence to HHV-8 antigens was high in HIV positive individuals with low CD4/CD8 ratio, suggesting that HHV-8 is reactivated during the immunosuppressive state. Several polypeptides with apparent molecular weights of 34-38,000 and 40,000, which were specific to HHV-8, were identified by the immunoprecipitation test using the seropositive sera. Our results suggested that HHV-8 co-existed with HIV in HIV-1 carriers and the existence of HHV-8 may be associated with clinical features in the skin.

A specific T-cell subset with CD4+/CD38- markers derived from HIV-1 carriers induces apoptosis in healthy donor-derived T-lymphocytes.

Apoptosis is an important mechanism of human immunodeficiency virus type 1 (HIV-1)-induced T-cell depletion. Our recent findings revealed mitogenic stimulation-dependent apoptosis induction in healthy donor-derived peripheral blood T-lymphocytes after adsorption with defective HIV-1 particles through acquirement by a subset of CD4+/CD38- cells of specific killer function. Based on these in vitro observations, we have extended the significance of this killing activity of CD4+/CD38- cells directly derived from HIV-1 carriers. The CD4+/CD38- cells from HIV-1-positive individuals showed significantly higher cell-killing activities than those from HIV-1-negative donors by co-culture with allogeneic resting T-cells after mitogenic stimulation. Furthermore, most of the samples induced apoptosis in a Fas-dependent manner. Thus, it is suggested that HIV-1 infection-related apoptosis is triggered by inappropriate activation of a certain resting T-cell subset, presumably due to adsorption with HIV-1 particles.

Development of peptide vaccines inducing production of neutralizing antibodies against HIV-1 viruses in HLA-DQ6 mice.

Peptide vaccines against HIV-1 were prepared according to the cassette theory that we had proposed previously. An amino acid sequence of B subtype consensus of the HIV-1 V3 region was introduced into the MHC binding component with a supermotif for various MHC class II. The peptide vaccines induced T-cell responses in the DQ6 mice in which only DQ6 molecules were expressed as MHC class II. By contrast, an original V3 peptide including the consensus sequence was non-immunogenic in the DQ6 mice. Antibodies obtained from the DQ6 mice immunized with the peptide vaccines neutralized laboratory B subtype strains of HIV-1 in vitro. It may be anticipated that these peptide vaccines protect infection of HIV-1 in DQ6 positive individuals.

Exposure of resting peripheral blood T cells to HIV-1 particles generates CD25+ killer cells in a small subset, leading to induction of apoptosis in bystander cells.

Apoptosis is a major mechanism whereby HIV-1 depletes uninfected CD4+ and CD8+ T cells. We previously showed that resting peripheral blood T cells derived from healthy donors were killed by an apoptotic mechanism after adsorption to gp120-containing, protease-defective HIV-1 (L-2) particles, more effectively than parental wild-type LAI adsorption or rgp 120-mediated CD4 cross-linking, followed by mitogenic stimulation. Here, we present evidence that the L-2 particle-based apoptosis was induced both in CD4+ and CD8+ cells by generation of effector cells which were mainly derived from a resting memory CD4+CD38- subset. This subset enhanced the CD25 expression on the surface and secreted IFN-gamma in the culture supernatant after L-2 particle exposure. Significant elevation of Fas ligand mRNA was found in the subset by L-2 particle exposure, while expression of Fas antigen on uninfected T cells was induced by exposure to IFN-gamma. These results indicate that L-2 particles can shift the CD4+CD38- subpopulation from a resting to an activated state, and this activation leads to killing of bystander CD4+ and CD8+ T cells by a Fas-mediated mechanism. In fact, purified CD4+CD38- cells exposed to L-2 particles were converted into effector cells that were able to kill autologous as well as allogenic target T cells pretreated with IFN-gamma. Further, we found that the observation of apoptosis due to L-2 particles was a more general phenomenon, that also occurred with Thai primary HIV-1 isolates. These results suggest that such specific types of HIV-1 particles may play a major role in the induction of apoptosis for both bystander CD4+ and CD8+ T cells, through inappropriate activation of CD4+CD38- cells.

Unusually high seroprevalence of Borna disease virus in clade E human immunodeficiency virus type 1-infected patients with sexually transmitted diseases in Thailand.

The seroprevalence of Borna disease virus (BDV) in human immunodeficiency virus type 1-infected individuals in Thailand was examined by using recombinant BDV p24. A high (38 to 48%) rate of seroprevalence of BDV was observed in clade E-infected patients with sexually transmitted diseases, compared with those in clade E-infected prostitutes (8.3%), pregnant women (0%), clade B-infected intravenous-drug users (0%), and human immunodeficiency virus type 1-negative blood donors (1.9%).

PIP: Borna disease virus (BDV) is a neurotropic, yet unclassified, nonsegmented, negative-sense, single-stranded RNA virus which naturally infects horses and sheep, and induces a disease characterized by a progressive meningoencephalopathy. It has been suggested that BDV, or a related agent, is associated with specific psychiatric disorders. Previous seroprevalence studies of HIV-1-infected individuals identified a BDV seroprevalence of 4-8% at the early stage of HIV-1 infection which grew to 13.9% in later stages. BDV may be more widespread than previously thought and possible reactivated in immunosuppressed patients. BDV seroprevalence in HIV-1-infected individuals in Thailand was examined using recombinant BDV p24. The rates of infection were 38-48% in clade E-infected patients with sexually transmitted diseases, 8.3% in clade E-infected prostitutes, 0% in pregnant women, 0% in clade B-infected IV drug users, and 1.9% in HIV-1-negative blood donors.

Independent introduction of two major HIV-1 genotypes into distinct high-risk populations in Thailand.

To investigate the genetic heterogeneity and epidemiological distribution of human immunodeficiency virus type 1 (HIV-1) in Thailand, we determined proviral sequences for 63 HIV-1-infected patients in various risk groups from all over the country between April and July, 1991. Two distinct genotypes of HIV-1, A and B, were found to segregate by mode of transmission. Of 29 sexually infected patients, 25 (86%) had HIV-1 of genotype A and 4 (14%) had genotype B. Among 29 injecting drug users, probably parenterally infected, only 7 (24%) had genotype A and 22 (76%) had genotype B. This segregation is unlikely to have arisen by chance (p < 0.001). No patient was found to have dual infection. Nucleotide divergence averaged 3.4% among genotype-A-infected patients and 3.5% among genotype-B-infected patients, but 22.0% between the genotypes. 37 of 40 isolates (both genotypes) had the GPGQ tetrapeptide at the tip of the V3 loop, which is common in African HIV-1 strains but rare in North American and European strains, where the GPGR motif predominates. These findings suggest that the waves of HIV-1 infection in injecting drug users and in sexually infected patients in Thailand may not be epidemiologically linked. The nucleotide divergence data point to the separate introductions of the two genotypes in Thailand. Further studies in Thailand and neighbouring countries will be useful in the design and selection of candidate HIV vaccines.

Highly specific V3 peptide enzyme immunoassay for serotyping HIV-1 specimens from Thailand.

OBJECTIVE: To develop and evaluate a simple V3 peptide-based enzyme immunoassay (EIA) for large-scale serotyping of HIV-1 specimens from Thailand. DESIGN: Serologic reactivities with synthetic peptides derived from the V3 loop of gp120 were used for typing HIV-1 specimens. METHODS: Synthetic peptides PND-A and PND-B, derived from the consensus amino-acid sequences of the V3 loop of gp120 from two major genomic variants of HIV-1 in Thailand (A and B), were evaluated in an EIA on 61 Thai HIV-1 sera for which genotypes had been determined by polymerase chain reaction. The peptide EIA was then applied to sera from 188 HIV-1-infected patients, selected in non-random, convenience samples of known risk groups from four geographic regions of Thailand. RESULTS: The sensitivities and specificities of PND-A and PND-B were 86% (30 out of 35) and 96% (25 out of 26) and 92% (24 out of 26) and 94% (33 out of 35), respectively, with 100% predictive values of a monoreactive positive test for both peptides. The assay classified 101 specimens as serotype A, 39 as serotype B, eight as serotype AB (dually reactive), and 40 as untypable (non-reactive). Excluding dual reactors and non-reactors, 92% (77 out of 84) of specimens from patients probably infected by sexual contact were serotype A; conversely, 76% (28 out of 37) of injecting drug users were serotype B. CONCLUSION: The serologic results corroborated previous findings, in a smaller subset of samples, of an apparent segregation of viral subtypes by mode of transmission, suggesting two separate HIV-1 epidemics in Thailand. This peptide EIA could be a valuable epidemiologic tool in determining the dynamics of the rapid spread of HIV-1 in Thailand.

PIP: A simple synthetic enzyme immunoassay (EIA) for serotyping HIV-1 specimens from Thailand, based on gp120 V3 loop peptide, was developed and tested on 188 sera from 4 regions of the country. There are 2 major known gene variants of HIV-1 in Thailand designated genotype A and B. The peptide EIA was tested on 61 sera that had been characterized by polymerase chain reaction and DNA sequencing. The EIA was then tested on 188 sera from high risk groups collected in the northern, northeastern, central and southern regions in mid-1991. The PND-A assay was 86% sensitive and 96% specific; the PND-B assay was 96% sensitive and 92% specific. The EIAs showed 100% predictive values when sera known to be reactive to only HIV A or B were tested. In the series there were also 8 sera reactive to both A and B and 40 not reactive to either variant. Excluding dual and non-reactors, 92% of patients with sexual high risk factors had HIV-1 type A and 76% of those with IV drug use history had type B. The results suggest that 2 HIV-1 epidemics have occurred in Thailand, an initial wave in 1988 among IV drug users and a later wave centered among prostitutes and their clients.

A preliminary survey for human immunodeficient virus (HIV) infections in tuberculosis and melioidosis patients in Ubon Ratchathani, Thailand.

A preliminary survey was conducted for the prevalence of HIV infections in pulmonary tuberculosis and melioidosis patients in Ubon Ratchathani province, in Thailand, the second largest province in population which supplies labors to Bangkok metropolis. In this province, tuberculosis is prevalent in a higher rate than in most other provinces and melioidosis is endemic. Four HIV-seropositives were found in a total of 551 suspected and culture-positive cases of pulmonary tuberculosis, while no HIV-seropositive was found in 121 melioidosis patients. In view of the rapidly expanding HIV-infections in Thailand, a strict watch will be needed on the future epidemiological status of HIV-infection in tuberculous patient.

PIP: HIV infection develops not only to AIDS, but it is also a leading risk factor for the development of many other infectious diseases due to the depletion of T lymphocytes such as the interrelated prevalence of tuberculosis (TB) and AIDS. Surveillance conducted in the 1988-1989 in the US and other recent studies found a serious epidemiological relation. Thailand has an endemic disease, melioidosis, caused by P. pseudomallei living in environmental soil and water. The disease takes various clinical types; localized, systemic, acute, subacute, chronic, and inapparent; presenting symptoms undistinguishable from many other infectious diseases. Pulmonary melioidosis shows a clinical feature similar to lung tuberculosis which occurs more easily in the individuals of impaired immunity, such as diabetes patients. According to available literatures, one case of recurrent melioidosis has been reported in Thailand as a complication of AIDS. The patient was a German homosexual male who had been living in the country for more than 10 years and showed a fatal course with interstitial pneumonitis. Ubon Ratchathani province, Thailand, is an area endemic for both TB and melioidosis, as well as a major supplier of laborers to Bangkok. A preliminary survey was conducted for the prevalence of HIV infections in pulmonary TB and melioidosis patients in Ubon Ratchathani province. TB was found to be prevalent in the province to a greater extent than in most other provinces and melioidosis is endemic. Four individuals were found to be HIV-seropositive amid a total 551 suspected and culture-positive cases of pulmonary TB, while no HIV-seropositive case was found among 121 melioidosis patients. In view of the rapidly expanding HIV-infections in Thailand, careful attention will have to be given to the future epidemiological status of HIV infection in TB patients.

Wide distribution of two subtypes of HIV-1 in Thailand.

PIP: Scientists wanted to identify the genetic characteristics of 2 HIV-1 subtypes in Thailand. Staff from regional laboratories of the Ministry of Public Health took blood samples from people in various high risk groups and from all regions of the country. Staff at the National Institutes of Health in Bangkok then did lymphocyte separation, DNA extraction, and virus culture. They took the extracted DNA specimens and sent them to the US Centers for Disease Control where scientists did serologic testing, polymerase chain reaction, and sequence determination. They used Kimura's method to study sequence variations. They sequenced 300 nucleotides, including the C2-V3 domains of HIV-1 envelope gene and/or hybridization. Every risk group had HIV-1 subtype A, but subtype B was mostly found in drug users. Subtype A had spread mainly among heterosexuals. The mean intraperson variation for subtypes A and B stood at 2% and 2.7%, respectively, while the interperson variation within subtype A and B stood at 3.8% and 3.7%, respectively. The mean interperson variation between subtypes A and B from different persons was 18.1%. Phylogenetic tree analysis showed that subtype B identified with about 85% of the sequence as that of the North American isolates, making it more closely related to them than to African isolates (about 75% sequence identity). On the other hand, subtype A had a GPGQ motif at the V3 crown which was common among African HIV-1 isolates. Antibodies which usually recognize HIV-1 MN strains (which have the GPGR motif) may not react wholly with the V3 loop from the Thailand subtype A viruses, thus the GPGQ motif at the V3 crown may pose a problem. Now for the first time, scientists can follow the natural history of 2 HIV-1 subtypes and determine their relative pathogenicity and transmission efficiency between adults or from mother to infant. The relative homogeneity of the HIV-1 strains in Thailand presents a theoretical advantage in designing vaccines for potential large-scale clinical trials.^ieng

Immunofluorescence, enzyme-linked immunosorbent assay, particle agglutination and western blot for the detection of antibody to human immunodeficiency virus type 1.

Immunofluorescence assay (IFA) has been applied for detection of antibody to human immunodeficiency virus type 1 (HIV-1). To compare the IFA with an enzyme-linked immunosorbent assay (ELISA) and particle agglutination (PA), we examined the antibody response to HIV-1 in 475 sera from AIDS, PGL and ARC patients as well as several risk groups and healthy persons by three methods. The positive results by any methods were confirmed by western blot (WB). The results by all methods were well correlated on the sera from 45 asymptomatic male homosexuals and 70 female prostitutes. There were some false positive results by ELISA in the sera from prisoners and healthy persons. Four sera from drug abusers were positive only by PA and IFA and were negative by ELISA. All were WB-inconclusive. Particle agglutination and IFA results were compared with western blot analysis on 208 ELISA-positive sera. All IFA-strongly positive sera (84%) were positive by western blot. The sera with weakly positive, negative and inconclusive results by IFA (16%) were possibly any of positive, inconclusive or negative by western blot. By PA, 200 of 208 (97%) sera were PA-positive and 1% of these sera were WB-inconclusive while the PA-negative sera were either negative or inconclusive by western blot. These results suggested that PA is a simple and sensitive method for screening of HIV-1 antibody while IFA could be a primary confirmatory test and western blot would then be used for confirming any IFA-negative or inconclusive results.

Prevalence of antibody to human herpesvirus 6 in women and children.

The antibody prevalence to human herpesvirus 6 (HHV-6) was compared between pregnant women and control women of similar ages in Thailand. No significant difference was detected in the antibody positive rate and antibody titers between both groups. The antibody titers in sera collected from pregnant women at 1st and 3rd trimester remained unchanged. Next, the antibody prevalence in infants were examined and the positive rate decreased until 3 months and started to increase from 6 months after birth. The present results suggest that the reactivation of HHV-6 might not occur during pregnancy and this virus infects infants postnatally.