RESUMEN
Human leukocyte antigen (HLA) alleles have been linked to HIV disease progression and attributed to differences in cytotoxic T lymphocyte (CTL) epitope representation. These findings are largely based on treatment-naive individuals of European and African ancestry. We assessed HLA associations with HIV-1 outcomes in 1,318 individuals from Thailand and found HLA-B∗46:01 (B∗46) associated with accelerated disease in three independent cohorts. B∗46 had no detectable effect on HIV-specific T cell responses, but this allele is unusual in containing an HLA-C epitope that binds inhibitory receptors on natural killer (NK) cells. Unbiased transcriptomic screens showed increased NK cell activation in people with HIV, without B∗46, and simultaneous single-cell profiling of surface proteins and transcriptomes revealed a NK cell subset primed for increased responses in the absence of B∗46. These findings support a role for NK cells in HIV pathogenesis, revealed by the unique properties of the B∗46 allele common only in Asia.
Asunto(s)
Infecciones por VIH , Antígenos HLA-B , Progresión de la Enfermedad , Epítopos , Infecciones por VIH/metabolismo , Antígenos HLA-B/genética , Antígenos HLA-B/metabolismo , Humanos , Células Asesinas Naturales , FenotipoRESUMEN
Since 2010, the Thailand Ministry of Public Health has recommended that men who have sex with men (MSM) have an HIV test at least two times a year. We calculated the proportion of, and factors associated with, testing adherence among the HIV-uninfected MSM clients attending Silom Community Clinic @TropMed. We defined testing adherence as repeating at least one HIV test within six months of an initial HIV-negative test, and used log-binomial regression to test for associated factors. We included 1927 clients during 20112014; 362 (19%) were adherent with an increased trend (p < 0.01), from 16% to 24%. Clients aged 1824 years and those having a history of HIV testing were more likely to adhere (aRR: 1.3, 95% CI: 1.11.6; and aRR: 1.3, 95% CI: 1.01.5, respectively). One-fifth adhered to the recommendation; older clients or naïve testees were less likely to adhere. We need to impress on clients the importance of repeat HIV testing.
Asunto(s)
Infecciones por VIH/prevención & control , Seronegatividad para VIH , Homosexualidad Masculina/estadística & datos numéricos , Tamizaje Masivo/estadística & datos numéricos , Adolescente , Adulto , Humanos , Masculino , Asunción de Riesgos , Conducta Sexual , Tailandia/epidemiología , Adulto JovenRESUMEN
We report positivity rates of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infection at each anatomic site among asymptomatic men who have sex with men (MSM). We calculated the number needed to screen (NNS) to detect CT and NG infection at each anatomic site. From 2006 to 2010, we enrolled Thai MSM, age ≥ 18 years into the Bangkok MSM Cohort Study. Participants underwent physical examination and had rectal, urethral, and pharyngeal screening for CT and NG infection using nucleic acid amplification tests (NAATs). Of 1744 enrollees, 1696 (97.2%) had no symptoms of CT and NG infection. The positivity rates of CT and NG infection at any site were 14.3% (rectum, urethra, pharynx) and 6.4% (rectum, urethra), respectively. The NNS to detect rectal CT and rectal NG infections was 10 and 16, respectively (p < 0.05). For urethral infection, the NNS of CT was lower than the NNS of NG (22, 121: p < 0.05). The lowest NNS found for rectal CT infection was in HIV-infected MSM (6, 5-8). Asymptomatic CT and NG infection were common among MSM in Bangkok, Thailand and frequently detected in the rectum. In setting where screening in all specimens using NAAT is not feasible, rectal screening should be a priority.