Knowledge and Behaviors toward Human Papillomavirus and Cervical Cancer in the Women of Reproductive Age in Thailand-Myanmar Border Areas.

BACKGROUND: Infectious disease is an important health problem in border areas as there is a possibility that the migrants may carry the disease into the area. The purpose of this study is to evaluate the knowledge and behaviors toward human papillomavirus (HPV) and cervical cancer in the women of reproductive age in the Thailand-Myanmar border area. METHODS: A survey study in a population of 418 women of reproductive age in Mae Hong Son Province in the Thailand-Myanmar border area. Knowledge and risk behaviors of HPV and cervical cancer were described using descriptive statistics. RESULTS: Fifty percent of the participants had sexual debut at age less than 20 years, 27% had more than one lifetime sexual partner and only 3% had sex outside a monogamous relationship during the past 12 months. In term of knowledge, 62.5% knew about HPV. The proportion of correct answers about HPV and cervical cancer questions ranged from 14-95% and 52-94%, respectively. Among the cervical cancer screening target, 69.4% accessed the screening. The factors associated with better knowledge about HPV and cervical cancer were education level higher than high school and sexual debut. CONCLUSION: The women of reproductive age in the Thailand-Myanmar border areas showed relatively low sexually risk behaviors for HPV infection. More than one-third of the participants did not know about HPV. The percentage of correct answer to questions about cervical cancer were low.  We encourage the Thai Ministry of Public Health to increase health promotion and health literacy on prevention of HPV and cervical cancer in the women of pre- and reproductive age in the Thailand-Myanmar border area.

High mortality in adolescents and young adults with perinatally-acquired HIV in Thailand during the transition to adulthood.

Transitioning from pediatric to adult care remains a challenge for adolescents and young adults with perinatally-acquired HIV (AYA-PHIV). We assessed treatment outcomes and mortality among Thai AYA-PHIV. The study included AYA-PHIV who reached age 18-24 years who started antiretroviral treatment during childhood at five pediatric HIV clinics across Thailand. From November 2020-July 2021, data were gathered from a cohort database, medical records, and the Thai National AIDS Program. Of 811 eligible AYA-PHIV, 93% were alive; median age 22.3 years (IQR 20.6-23.7), treatment duration 16.1 years (IQR 13.4-18.0). Current HIV care was provided in adults (71%) and pediatric clinics (29%). Treatment regimens included non-nucleoside reverse transcriptase inhibitors (55%), protease inhibitors (36%), and integrase inhibitors (8%); 78% had HIV RNA <200 copies/ml. Of the 7.0% who died, median age at death was 20.8 years (IQR 20.6-22.1); 88% were AIDS-related death. Mortality after age 18 was 1.76 per 100-person years (95% confidence interval 1.36-2.28). Those with CD4 <200 cell/mm3 at age 15 had higher risk of mortality (adjusted hazard ratio 6.16, 95% CI 2.37-16.02). In conclusion, the high mortality among Thai AYA-PHIV indicated the need for better systems to support AYA-PHIV during the transition to adulthood.

Weight Changes and Adverse Pregnancy Outcomes With Dolutegravir- and Tenofovir Alafenamide Fumarate-Containing Antiretroviral Treatment Regimens During Pregnancy and Postpartum.

BACKGROUND: We evaluated associations between antepartum weight change and adverse pregnancy outcomes and between antiretroviral therapy (ART) regimens and week 50 postpartum body mass index in IMPAACT 2010. METHODS: Women with human immunodeficiency virus (HIV)-1 in 9 countries were randomized 1:1:1 at 14-28 weeks' gestational age (GA) to start dolutegravir (DTG) + emtricitabine (FTC)/tenofovir alafenamide fumarate (TAF) versus DTG + FTC/tenofovir disoproxil fumarate (TDF) versus efavirenz (EFV)/FTC/TDF. Insufficient antepartum weight gain was defined using Institute of Medicine guidelines. Cox-proportional hazards regression models were used to evaluate the association between antepartum weight change and adverse pregnancy outcomes: stillbirth (≥20 weeks' GA), preterm delivery (<37 weeks' GA), small size for GA (<10th percentile), and a composite of these endpoints. RESULTS: A total of 643 participants were randomized: 217 to the DTG + FTC/TAF, 215 to the DTG + FTC/TDF, and 211 to the EFV/FTC/TDF arm. Baseline medians were as follows: GA, 21.9 weeks; HIV RNA, 903 copies/mL; and CD4 cell count, 466/µL. Insufficient weight gain was least frequent with DTG + FTC/TAF (15.0%) versus DTG + FTC/TDF (23.6%) and EFV/FTC/TDF (30.4%). Women in the DTG + FTC/TAF arm had the lowest rate of composite adverse pregnancy outcome. Low antepartum weight gain was associated with higher hazard of composite adverse pregnancy outcome (hazard ratio, 1.44 [95% confidence interval, 1.04-2.00]) and small size for GA (1.48 [.99-2.22]). More women in the DTG + FTC/TAF arm had a body mass index ≥25 (calculated as weight in kilograms divided by height in meters squared) at 50 weeks postpartum (54.7%) versus the DTG + FTC/TDF (45.2%) and EFV/FTC/TDF (34.2%) arms. CONCLUSIONS: Antepartum weight gain on DTG regimens was protective against adverse pregnancy outcomes typically associated with insufficient weight gain, supportive of guidelines recommending DTG-based ART for women starting ART during pregnancy. Interventions to mitigate postpartum weight gain are needed.

Health Behaviors and Attitudes Toward HIV Clinic Among Young Men who Have Sex with Men Living with HIV in Chiang Mai, Thailand: A Mixed Methods Study.

Today, many young men who have sex with men (YMSM) with a new HIV infection were diagnosed and successfully linked to HIV services. Studies on their health behaviors while living with HIV and their attitude toward the HIV clinic are scarce. We characterized common health behaviors of YMSM and assessed their perspective towards the existing HIV services. We collected data from a self-administered questionnaire and in-depth interviews (IDI) using a mixed-method cross-sectional study design. A hundred YMSM, aged 18-24, who attended the HIV clinic were enrolled. Their median age was 23 years (interquartile range, IQR 21-24). Eighty-four (84%) were gay men. Their common health behaviors included 15 (15%) being current smokers and 30 (30%) using alcohol regularly. Sixty-four (64%) reported > 95% antiretroviral treatment adherence, while 32 (32%) self-reported adherence at 80-95%. Fifty-three (53%) reported 100% condom use, while 30 (30%) reported using a condom in > 80% of their sexual activities. From the questionnaire respondents, individual characteristics of providers were the most critical factor affecting participants' willingness to attend HIV services. From the IDI, social disclosure of HIV status was their primary concern, with the presence of self- and anticipating HIV-related stigma issues. In summary, YMSM living with HIV who regularly attended the HIV clinic had a low frequency of health risk behaviors. Most did not socially disclose their serostatus but could manage their health. They were generally satisfied with patient-friendly services while calling to protect their confidentiality and privacy.

Incidence of Respiratory Syncytial Virus-Associated Lower Respiratory Tract Illness in Infants in Low- and Middle-Income Regions During the Coronavirus Disease 2019 Pandemic.

Background: Incidence data of respiratory syncytial virus-associated lower respiratory tract illness (RSV-LRTI) are sparse in low- and middle-income countries (LMICs). We estimated RSV-LRTI incidence rates (IRs) in infants in LMICs using World Health Organization case definitions. Methods: This prospective cohort study, conducted in 10 LMICs from May 2019 to October 2021 (largely overlapping with the coronavirus disease 2019 [COVID-19] pandemic), followed infants born to women with low-risk pregnancies for 1 year from birth using active and passive surveillance to detect potential LRTIs, and quantitative reverse-transcription polymerase chain reaction on nasal swabs to detect RSV. Results: Among 2094 infants, 32 (1.5%) experienced an RSV-LRTI (8 during their first 6 months of life, 24 thereafter). Seventeen (0.8%) infants had severe RSV-LRTI and 168 (8.0%) had all-cause LRTI. IRs (95% confidence intervals [CIs]) of first RSV-LRTI episode were 1.0 (.3-2.3), 0.8 (.3-1.5), and 1.6 (1.1-2.2) per 100 person-years for infants aged 0-2, 0-5, and 0-11 months, respectively. IRs (95% CIs) of the first all-cause LRTI episode were 10.7 (8.1-14.0), 11.7 (9.6-14.0), and 8.7 (7.5-10.2) per 100 person-years, respectively. IRs varied by country (RSV-LRTI: 0.0-8.3, all-cause LRTI: 0.0-49.6 per 100 person-years for 0- to 11-month-olds). Conclusions: RSV-LRTI IRs in infants in this study were relatively low, likely due to reduced viral circulation caused by COVID-19-related nonpharmaceutical interventions. Clinical Trials Registration: NCT03614676.

Prevalence and Genotypic Diversity of Human Papillomavirus Infection Among Male and Female Sex Workers in Thailand.

BACKGROUND: Human papillomavirus (HPV) is associated with cancer. Female sex workers (FSWs) are known to be at risk for HPV, but little is known about male sex workers (MSWs). METHODS: We examined HPV prevalence and associated risk factors in both populations. During 2022, HPV testing using vaginal or penile samples, HIV testing, and interviews were performed among 100 MSWs and 100 FSWs in Chiang Mai, Thailand. RESULTS: The prevalence of all HPV types was 63.5% (66% in MSW, 61% in FSW), HPV-16 prevalence was 14%, HPV-52 was 13%, and HPV-18 was 4%. There was no difference between MSW and FSW for these subtypes. The prevalence of HPV-16 or HPV-18 was 17%, and for HPV-16, HPV-18, or HPV-52, it was 26%. HIV-positive participants had a higher prevalence of all HPV types (94% vs. 60%, P = 0.004), HPV-16 or HPV-18 (39% vs. 15%, P = 0.018), and HPV-16, HPV-18, or HPV-52 (50% vs. 23%, P = 0.017). CONCLUSIONS: We demonstrated an equally high HPV prevalence across the sexes. Further studies are needed to determine if this indicates an equal risk for cancer. Increased HPV awareness, screening, and vaccination should be considered, regardless of gender.

Efficacy, Safety, and Tolerability of Doravirine/Lamivudine/Tenofovir Disoproxil Fumarate Fixed-Dose Combination Tablets in Adolescents Living With HIV: Results Through Week 96 from IMPAACT 2014.

BACKGROUND: IMPAACT 2014 study is a phase I/II, multicenter, open-label, nonrandomized study of doravirine (DOR) co-formulated with lamivudine (3TC) and tenofovir disoproxil fumarate (TDF) as fixed-dose combination (DOR FDC) in adolescents with HIV-1. We report the efficacy, safety, and tolerability of DOR FDC through 96 weeks. METHODS: Participants were adolescents aged 12 to <18 years who weighed at least 45 kg and who were either antiretroviral (ARV)-naïve or virologically suppressed without documented resistance mutations to DOR/3TC/TDF. The efficacy endpoint was the proportion of participants with HIV-1 RNA <40 copies/mL assessed at weeks 48 and 96 using the observed failure approach. Safety and tolerability outcomes were incidence of adverse events (AEs) and treatment discontinuations. RESULTS: A total of 45 adolescents, median age 15 (range, 12-17) years, 58% females, were enrolled and 2 (4.4%) participants were ARV naïve. Of the 45 participants, 42 (93.3%) completed the study and 41 (91.1%) completed the study treatment. At week 48, 41/42 (97.6%; 95% confidence interval [CI], 87.4-99.9) and week 96, 37/40 (92.5%; 95% CI, 79.6-98.4) participants had achieved or maintained HIV-1 RNA <40 copies/mL. There were no treatment-related discontinuations due to AEs and no drug-related AEs ≥grade 3 or deaths. CONCLUSIONS: We found once-daily dosing of DOR FDC to be safe and well tolerated for maintaining viral suppression through 96 weeks in adolescents living with HIV-1.

Pharmacokinetics, safety, and tolerability of dispersible and immediate-release abacavir, dolutegravir, and lamivudine tablets in children with HIV (IMPAACT 2019): week 24 results of an open-label, multicentre, phase 1-2 dose-confirmation study.

BACKGROUND: Child-friendly fixed-dose combination (FDC) antiretroviral therapy (ART) options are limited. We evaluated the pharmacokinetics, safety, and tolerability of dispersible and immediate-release FDC abacavir, dolutegravir, and lamivudine taken once per day in children younger than 12 years with HIV. METHODS: IMPAACT 2019 was an international, phase 1-2, multisite, open-label, non-comparative dose-confirmation study of abacavir, dolutegravir, and lamivudine in children younger than 12 years. Participants were enrolled across five weight bands: those weighing 6 kg to less than 25 kg received abacavir (60 mg), dolutegravir (5 mg), and lamivudine (30 mg) dispersible tablets (three to six tablets depending on body weight), and those weighing 25 kg to less than 40 kg received abacavir (600 mg), dolutegravir (50 mg), and lamivudine (300 mg) in an immediate-release tablet. At entry, participants were ART naive or ART experienced and virologically suppressed on stable ART for 6 months or more. Dose confirmation was based on pharmacokinetic and safety criteria in the first five to seven participants in each weight band to week 4; all participants were followed up to week 48. We present the results for the primary objectives to assess pharmacokinetics, confirm dosing, and evaluate safety through 24 weeks across all weight bands. The trial is registered with ClinicalTrials.gov (NCT03760458). FINDINGS: 57 children were enrolled and initiated study drug (26 [46%] female and 31 [54%] male; 37 [65%] Black, 18 [32%] Asian, and 1 [2%] had race reported as unknown). Within each weight band, 6 kg to less than 10 kg, 10 kg to less than 14 kg, 14 kg to less than 20 kg, 20 kg to less than 25 kg, and 25 kg or higher: the geometric mean dolutegravir area under the concentration time curve over the 24 h dosing interval (AUC0-24 h) was 75·9 h·µg/mL (33·7%), 91·0 h·µg/mL (36·5%), 71·4 h·µg/mL (23·5%), 84·4 h·µg/mL (26·3%), and 71·8 h·µg/mL (13·9%); dolutegravir concentrations 24 h after dosage (C24 h) were 0·91 µg/mL (67·6%), 1·22 µg/mL (77·5%), 0·79 µg/mL (44·2%), 1·35 µg/mL (95·5%), and 0·98 µg/mL (27·9%); abacavir AUC0-24 h was 17·7 h·µg/mL (38·8%), 19·8 h·µg/mL (50·6%), 15·1 h·µg/mL (40·3%), 17·4 h·µg/mL (19·4%), and 25·7 h·µg/mL (14·6%); lamivudine AUC0-24 h was 10·7 h·µg/mL (46·0%), 14·2 h·µg/mL (23·9%), 13·0 h·µg/mL (15·6%), 14·5 h·µg/mL (16·6%), and 21·7 h·µg/mL (26·2%), respectively. Pharmacokinetic targets and safety criteria were met within each weight band, and thus dosing of abacavir, dolutegravir, and lamivudine was confirmed at the originally selected doses. 54 (95%) of participants were treatment experienced and all who continued taking the study drug remained virologically suppressed (<200 copies per mL) through week 24. Virological suppression was achieved in two of three participants who were ART naive by week 24. There were no grade 3 or higher adverse events related to abacavir, dolutegravir, and lamivudine and no discontinuations because of toxicity to week 24. Both formulations were well tolerated. INTERPRETATION: Dosing of abacavir, dolutegravir, and lamivudine was confirmed in children weighing 6 kg to less than 40 kg, and both FDC formulations were safe, well tolerated, and efficacious through 24 weeks of treatment. These findings support global efforts to expand the availability of FDC abacavir, dolutegravir, and lamivudine to children with HIV. FUNDING: National Institute of Allergy and Infectious Diseases, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute of Mental Health, ViiV Healthcare, and GlaxoSmithKline.

Social effects of HIV disclosure, an ongoing challenge in young adults living with perinatal HIV: a qualitative study.

Introduction: Young adults with perinatal HIV (YAPHIV) have survived the long journey of life while living with HIV since early childhood. We explore the HIV disclosure experience and its social effects from their perspectives. Methods: The qualitative study was conducted from June to November 2022 in Chiang Mai, Thailand. Data were collected through individual in-depth semi-structured interviews with 20 YAPHIV at the median age of 25 years. Content analysis was used to identify themes from the interview transcripts. Results: Most participants learned their HIV status from their parents, caregivers, healthcare providers, or other people in community during their childhood. Some were disclosed later in adolescent years. HIV disclosure to others was associated with various experiences in different stages of life. While some YAPHIV decided not to disclose their HIV status to anyone, it also had social effects. Three major themes were identified: (1) positive social effects of HIV disclosure (perceived social acceptance, perceived social support); (2) negative social effects of HIV disclosure (effects on child rearing, schooling, and family relationship); and (3) HIV non-disclosure (anticipated stigma, negative effects on the quality of employment, and relationships). An emerging theme was a need for peer support mentioned by several YAPHIV as they would like to discuss with somebody and share their feelings while living with HIV. Conclusion: HIV disclosure remains challenging for YAPHIV while growing up and moving toward adult milestones. Better understanding their situations and perspectives would allow healthcare providers to provide them with updated HIV knowledge, coping skills, and psychosocial support.

Chronic Kidney Disease and Accelerated Decline of Renal Function in Older Adults with HIV in Northern Thailand.

Kidney disease remains prevalent in people living with HIV even in the antiretroviral treatment era. We determine the frequency of chronic kidney disease (CKD), rate of renal function decline, and associated factors in older adults with HIV (OAHIV) aged ≥50 years in northern Thailand. We used data from the medical records and calculated the estimated glomerular filtration rate (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration equation. Of the 269 participants (58% women, 61.8 years median age), 7.1% had CKD (eGFR <60 mL/min per 1.73 m2). There were 21 OAHIV (7.8%) with >25% decline in eGFR in the past year, 90 (33%) with accelerated (>5 mL/min per 1.73 m2 per year), and 44 (16%) with rapid (>10 mL/min per 1.73 m2 per year) declining eGFR. Female gender was the only factor associated with an accelerated decline in eGFR (odds ratio, 2.307; 95% confidence interval, 1.331-3.998; p = .003). Continuous monitoring of renal function is recommended for OAHIV to guide treatment modification and intervention.

Effect of pregnancy versus postpartum maternal isoniazid preventive therapy on infant growth in HIV-exposed uninfected infants: a post-hoc analysis of the TB APPRISE trial.

Background: Isoniazid preventive therapy (IPT) initiation during pregnancy was associated with increased incidence of adverse pregnancy outcomes in the TB APPRISE trial. Effects of in utero IPT exposure on infant growth are unknown. Methods: This post-hoc analysis used data from the TB APPRISE trial, a multicentre, double-blind, placebo-controlled trial, which randomised women to 28-week IPT starting in pregnancy (pregnancy-IPT) or postpartum week 12 (postpartum-IPT) in eight countries with high tuberculosis prevalence. Participants were enrolled between August 2014 and April 2016. Based on modified intent-to-treat analyses, we analysed only live-born babies who had at least one follow-up after birth and compared time to infant growth faltering between arms to 12 weeks and 48 weeks postpartum in overall and sex-stratified multivariable Cox proportional hazards regression. Factors adjusted in the final models include sex of infant, mother's baseline BMI, age in years, ART regimen, viral load, CD4 count, education, and household food insecurity. Results: Among 898 HIV-exposed uninfected (HEU) infants, 447 (49.8%) were females. Infants in pregnancy-IPT had a 1.47-fold higher risk of becoming underweight by 12 weeks (aHR 1.47 [95% CI: 1.06, 2.03]) than infants in the postpartum-IPT; increased risk persisted to 48 weeks postpartum (aHR 1.34 [95% CI: 1.01, 1.78]). Maternal IPT timing was not associated with stunting or wasting. In sex-stratified analyses, male infants in the pregnancy-IPT arm experienced an increased risk of low birth weight (LBW) (aRR 2.04 [95% CI: 1.16, 3.68), preterm birth (aRR 1.81 [95% CI: 1.04, 3.21]) and becoming underweight by 12 weeks (aHR 2.02 [95% CI: 1.29, 3.18]) and 48 weeks (aHR 1.82 [95% CI: 1.23, 2.69]). Maternal IPT timing did not influence growth in female infants. Interpretation: Maternal IPT during pregnancy was associated with an increased risk of LBW, preterm birth, and becoming underweight among HEU infants, particularly male infants. These data add to prior TB APPRISE data, suggesting that IPT during pregnancy impacts infant growth, which could inform management, and warrants further examination of mechanisms. Funding: The TB APPRISE study Supported by the National Institutes of Health (NIH) (award numbers, UM1AI068632 [IMPAACT LOC], UM1AI068616 [IMPAACT SDMC], and UM1AI106716 [IMPAACT LC]) through the National Institute of Allergy and Infectious Diseases, with cofunding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (contract number, HHSN275201800001I) and the National Institute of Mental Health.

Trends in the Incidence of Kaposi's Sarcoma and Non-Hodgkin Lymphoma in Northern Thailand during the Time Period of Universal Access to Antiretroviral Treatment, 1998-2017.

PURPOSE: We evaluated the trends in incidence of Kaposi's sarcoma (KS) and Non-Hodgkin's lymphoma (NHL)  over the two decades in northern Thailand during which access to antiretroviral treatments (ART) in Thailand was scaled up. METHODS: This is retrospective observational study. Data from 1998 to 2017 of patients diagnosed with KS and NHL from three long-standing, population-based cancer registries in northern Thailand (Chiang Mai, Lampang and Lamphun) were used to describe trends in age-adjusted incidence rate (ASR) of these cancers. The annual percent change (APC) of incidence rates were evaluated over this timeframe. RESULTS: The incidence of KS significantly increased from 1998 to 2017 in males (APC of 6.9%) and very low incidence for evaluating change in female. NHL incidence significantly increased from 1998 to 2017, 2.2% and 1.8% per year in males and females, respectively (p<0.001). CONCLUSION: In the last two decades, the incidence of KS in male and NHL in both sexes have increased in northern Thailand, while the incidence of KS in female remained low. The change in incidences in opposite to the decline in HIV prevalence and increase ART coverage rate supported that other associated factors attributable to the development of KS and NHL should be looked for i.e., environmental, occupational exposures and other infections.

Characteristics, clinical outcomes, and mortality of older adults living with HIV receiving antiretroviral treatment in the sub-urban and rural areas of northern Thailand.

Since the introduction of antiretroviral treatment (ART), people living with HIV worldwide live into older age. This observational study described the characteristics, clinical outcomes, and mortality of older adults living with HIV (OALHIV) receiving ART from the National AIDS program in northern Thailand. Participants aged ≥ 50 years were recruited from the HIV clinics in 12 community hospitals. Data were obtained from medical records and face-to-face interviews. In 2015, 362 OALHIV were enrolled; their median (interquartile range) age and ART duration were 57 years (54-61), and 8.8 years (6.4-11.2), respectively. At study entry, 174 (48.1%) had CD4 counts ≥ 500 cells/mm3; 357 of 358 (99.6%) with available HIV RNA results were virologic-suppressed. At the year 5 follow-up, 39 died, 11 were transferred to other hospitals, 3 were lost to follow-up, and 40 did not contribute data for this analysis, but remained in care. Among the 269 who appeared, 149 (55%) had CD4 counts ≥ 500 cells/mm3, and 227/229 tested (99%) were virologic-suppressed. The probability of 5-year overall survival was 89.2% (95% confidence interval, CI 85.4-92.1%). A significantly low 5-year overall survival (66%) was observed in OALHIV with CD4 counts < 200 cells/mm3 at study entry. The most common cause of death was organ failure in 11 (28%), followed by malignancies in 8 (21%), infections in 5 (13%), mental health-related conditions in 2 (5%), and unknown in 13 (33%). In OALHIV with stable HIV treatment outcomes, mortality from non-infectious causes was observed. Monitoring of organ function, cancer surveillance, and mental health screening are warranted.

Alcohol use, suicidality and virologic non-suppression among young adults with perinatally acquired HIV in Thailand: a cross-sectional study.

INTRODUCTION: Young adults with perinatally acquired HIV (YA-PHIV) are facing transitions to adult life. This study assessed health risk behaviours (including substance use), mental health, quality of life (QOL) and HIV treatment outcomes of Thai YA-PHIV. METHODS: A cross-sectional study was conducted in Thai YA-PHIV aged 18-25 years who were enrolled in a prospective cohort study at five tertiary paediatric HIV care centres in Thailand. Study data were obtained through face-to-face interviews from November 2020 to July 2021. Assessments were performed for alcohol use (Alcohol Use Disorders Identification Test; AUDIT), smoking (Fagerstrom Test for Nicotine Dependence), drug/substance use (Drug Abuse Screening Test; DAST-10), depression (Patient Health Questionnaire for Adolescents; PHQ-A), anxiety (Generalized Anxiety Disorder; GAD-7) and QOL (World Health Organization QOL Brief-Thai). HIV treatment outcomes were extracted from the National AIDS Program database. RESULTS: Of 355 YA-PHIV, 163 (46%) were males: their median age was 21.7 (interquartile range, IQR 20.2-23.5) years. There were 203 YA-PHIV (58%) who reported ever having sex; 141 (40%) were sexually active in the past 6 months, of whom 86 (61%) reported 100% condom use. Overall, 49 (14%) met the criteria for harmful alcohol use; 28 (7.9%) were alcohol dependent. Sixty (17%) were current smokers and 37 (11%) used drugs/substances. The frequency of moderate up to severe symptoms for depression was 18% and for anxiety was 9.7%. Their overall QOL was good in 180 (51%), moderate in 168 (47%) and poor in five (1.4%). There were 49 YA-PHIV (14%) with CD4 <200 cells/mm3 and 85 (24%) with virologic non-suppression (HIV-RNA >200 copies/ml). On multivariate analyses, the highest education at the primary to high school or vocational school levels (adjusted odds ratio [aOR] 2.02, 95% CI 1.40-3.95, p 0.04), harmful alcohol use (aOR 2.48, 95% CI 1.24-4.99, p 0.01), alcohol dependence (aOR 3.54, 95% CI 1.51-8.31, p <0.01) and lifetime suicidal attempt (aOR 2.66, 95% CI 1.11-6.35, p 0.03) were associated with non-suppression. CONCLUSIONS: Regular screening for alcohol use and mental health, including suicidality, would be useful to identify YA-PHIV who need more intensive psychosocial support or referral services to ensure they can achieve and maintain a high QOL into adult life.

Acceptability and Feasibility of Genetic Testing to Assess Risk of HIV-Associated Neurocognitive Impairment Among Thai Adolescents and Young Adults.

Host genetic factors may modify the risk of developing HIV-associated neurocognitive impairment (HIV-NCI), and genetic research has the potential to inform novel treatments for HIV-NCI. However, there is a need to better understand the acceptability of genetic testing among distinct populations of people living with HIV at increased risk for HIV-NCI, such as young people living with perinatally acquired HIV (PHIV) in low- and middle-income countries, to gauge the feasibility of genetic research within these populations. This pilot study evaluated the acceptability and feasibility of genetic testing to assess risk of future neurocognitive problems in 50 Thai adolescents and young adults (13-24 years; Meanage = 19.16 [standard deviation = 3.09]; 52% female) with PHIV and demographically similar HIV-negative controls. Participants (25 PHIV; 25 controls) completed a survey assessing acceptability of and concerns about genetic testing and were asked to provide blood samples for genetic testing. Descriptive statistics and blood draw completion rates were produced and calculated. Reported concerns about genetic testing were grouped thematically and tallied. Independent t tests and chi-squares explored demographic differences between participants who reported concerns and peers. Results indicated 46 participants (92%) rated genetic testing as "acceptable" or "completely acceptable." Eight participants (16%) reported concerns about genetic testing. The most common concerns were related to genetic information being shared or misused. Compared with participants without concerns, participants who reported concerns had more years of education and were more likely to have postsecondary schooling. Regarding completion rates, 49 participants (98%) agreed to genetic testing and provided blood samples. Overall, results support the acceptability and feasibility of incorporating genetic testing into research investigating HIV-NCI among adolescents and young adults in Thailand. Findings provide important considerations for planning future genetic studies among young people in Thailand.

Association of cardio-ankle vascular index and future major adverse cardiovascular events in older adults living with HIV.

ABSTRACTIncreased arterial stiffness is an indicator of cardiovascular disease (CVD) and death in the general population. The cardio-ankle vascular index (CAVI) is a novel method for measuring arterial stiffness. This study investigated the utility of CAVI as a prognostic indicator of CVD and death in older adults living with HIV(OALHIV). Patients aged ≥50 taking antiretroviral treatment with no history of cardiovascular events enrolled from multiple centers in Chiang Mai, Thailand. Participants (N = 347) who underwent CAVI were followed up for five years. The primary endpoint was major adverse cardiovascular events (MACE): a composite of total deaths and hospitalizations due to myocardial infarction, coronary revascularization, stroke, and heart failure. Cox regression analysis determined between normal (<8) and high (≥8) CAVI against the incidence of MACE. Forty-five participants (13.0%) were diagnosed with MACE. The risk of MACE was more significant in high CAVI than normal CAVI (adjusted HR = 2.11, 95% confidence interval 1.06-4.20, p = 0.033). In OALHIV, CAVI was an independent prognosis of MACE, in addition to conventional CVD risk factors. CAVI-assisted to help identify high-risk patients showed the benefit of further evaluation and more intensive therapy to prevent CVD and death.

Quality of life and HIV adherence self-efficacy in adolescents and young adults living with perinatal HIV in Chiang Mai, Thailand.

We assessed the quality of life and HIV adherence self-efficacy of adolescents and young adults (AYA) with perinatal HIV infection (PHIV). This cross-sectional study was conducted in Chiang Mai, Thailand. AYA-PHIV aged between 15 and 25 years were enrolled, who all were initiated on antiretroviral treatment as children. The World Health Organization-quality of life-BREF questionnaire and the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES) were administered. A total of 111 AYA-PHIV were included, including 52 (47%) females. Their median age was 20.2 ± 2.6 years. The overall QOL was rated as favorable (good or very good) by 59.4% of AYA-PHIV. The highest score was seen in the social relationships domain followed by the environmental health domain. Males had a significantly lower score in the psychological health domain than females (p = 0.018). Simple linear regression revealed a negative association between male sex, physical, and psychological health domain scores. The overall mean HIV-ASES score was 7.79 ± 1.96 out of 10, with a trend toward lower scores in males (p = 0.062), and a weak positive correlation with QOL. Our study documented worse QOL and lower HIV adherence self-efficacy in male AYA-PHIV. The findings call for the design of tailored male-focused interventions.

Pharmacokinetics, Tolerability, and Safety of Doravirine and Doravirine/Lamivudine/Tenofovir Disoproxil Fumarate Fixed-Dose Combination Tablets in Adolescents Living With HIV: Week 24 Results From IMPAACT 2014.

BACKGROUND: We studied the pharmacokinetics (PK) and safety of 100-mg doravirine and doravirine/lamivudine/tenofovir disoproxil fumarate fixed-dose combination (100/300/300 mg DOR FDC) treatment in adolescents with HIV-1. METHODS: Adolescents ages 12 to younger than 18 years were enrolled in 2 sequential cohorts. Cohort 1 evaluated intensive PK and short-term safety of 100-mg single-dose doravirine in adolescents ≥35 kg. Cohort 2 participants either initiated treatment with DOR FDC (antiretroviral (ARV)-naïve) or switched to DOR FDC from a previous ARV regimen (virologically suppressed). The first 10 Cohort 2 participants had intensive PK evaluations, and safety, sparse PK, and HIV RNA were assessed through week 24. RESULTS: Fifty-five adolescents, median age 15.0 years and baseline weight 51.5 kg, were enrolled. Nine participants completed Cohort 1 PK assessments (8 of the 9 participants weighed ≥45 kg) and 45 initiated study drug in Cohort 2. The doravirine geometric mean (GM) AUC 0-∞ was 34.8 µM∙hour, and the GM C 24 was 514 nM after a single dose, with a predicted steady-state GM C 24,ss,pred of 690 nM. Cohort 2 enrolled adolescents weighing ≥45 kg. Plasma concentrations of doravirine, tenofovir, and lamivudine achieved by Cohort 2 participants were similar to those reported in adults. No drug-related serious or grade 3 or 4 adverse events occurred. Forty-two of 45 participants (93.3%; 95% CI: [81.7, 98.6]) achieved or maintained HIV-1 RNA <40 copies/mL. CONCLUSIONS: Doravirine and DOR FDC achieved target PK in adolescents with HIV-1. DOR FDC was well-tolerated and maintained excellent virologic efficacy through 24 weeks, offering a favorable option for adolescents.

Neurocognitive performance and quality of life of older adults with HIV on antiretroviral treatment in Northern Thailand.

INTRODUCTION: With virologic suppression and longer life expectancy, older adults with HIV (OAHIV) are at risk for neurocognitive impairment (NCI). This study investigated neurocognitive performance, quality of life (QOL) and the association between OAHIV determinants. METHODS: This cross-sectional study was conducted in OAHIV aged ≥ 50 years on antiretroviral treatment at community hospitals in Northern Thailand between September and November 2020. The Montreal Cognitive Assessment Thai Version (MoCA-T) and the Thai-validated Medical Outcomes Study HIV (MOS-HIV) were used. NCI was defined as MoCA-T scores <25: 16-24 for amnestic mild cognitive impairment (aMCI) and <16 for dementia. For QOL, higher scores meant better QOL; a physical health summary T-score ≥50 was defined as good QOL. RESULTS: Overall, 269 OAHIV were enrolled; 59% were female and 99% had virologic suppression. The current median age was 61.8 years (interquartile range [IQR] 58.9-65.7). The median duration of antiretroviral treatment was 10.5 years (IQR 8.5-13.5). The current median CD4 count (234 tested) was 484 cells/mm3 (IQR 339-634), and 99% had plasma HIV RNA <40 copies/ml (229 tested). The median MoCA-T score was 20.0 (IQR 16.3-23.0). There were 234 OAHIV (87.3%) with NCI: 182 (67.9%) with aMCI and 52 (19.4%) with dementia. A hundred and ninety (70.6%) had good QOL. Bivariate analysis revealed no correlation between MoCA-T scores and QOL. Multivariable linear regression analysis revealed that MoCA-T score was associated with older age (r = -0.144, p = 0.002), lower education (r = 0.629, p < 0.001), lower income (r = 0.797, p = 0.040) and shorter treatment duration (r = 0.189, p = 0.006). CONCLUSIONS: The vast majority of OAHIV with virologic suppression had NCI. Approximately two-thirds had a mild impairment and one-fifth had dementia. Neurocognitive performance and QOL were not correlated. Addressing mild NCI would enable more targeted monitoring. Early intervention and support could minimize functional impairment with increased age.

Adaptation and construct validity evaluation of a tablet-based, short neuropsychological test battery for use with adolescents and young adults living with HIV in Thailand.

OBJECTIVE: Deficits in neurocognitive functioning are common among adolescents and young adults (AYA) with perinatally acquired HIV (PHIV). Limitations of traditional neuropsychological tests hinder assessment of neurocognition in low- and middle-income countries where most AYA with PHIV reside. Computerized testing could make assessment of neurocognition more accessible in these countries. This study examined a culturally modified NeuroScreen, a tablet-based neurocognitive testing app, for use in Thailand. Construct validity was examined among Thai AYA (13-23 years) with and without PHIV. METHOD: NeuroScreen underwent adaptation including language, content, and usability review by Thai psychologists, AYA, and clinical staff. One hundred Thai AYA (50 PHIV; 50 HIV-uninfected, matched controls) were administered the adapted NeuroScreen and a battery of traditional paper-and-pencil neuropsychological tests. Correlations, mean differences, and proportions with impaired performance were examined across NeuroScreen and the traditional tests. RESULTS: The Thai version of NeuroScreen was deemed understandable and culturally appropriate. A large correlation (.82) between overall performance on the NeuroScreen and traditional batteries was observed. Small-to-large correlations were found between conceptually similar NeuroScreen and traditional tests of processing speed, working memory, motor speed, and executive functioning. Mean test performance differences between AYA with PHIV and controls were similar between test batteries. Both sets of tests identified similar rates of impaired participants. CONCLUSIONS: Results provide support for the acceptability and construct validity of the Thai NeuroScreen tests to assess neurocognition in Thai AYA with PHIV. An easy-to-use tool to assess neurocognition can help Thai providers provide better care for AYA with PHIV. (PsycInfo Database Record (c) 2022 APA, all rights reserved).