Reproductive health, social life and plans for the future of adolescents growing-up with HIV: a case-control study in Thailand.

Most perinatally HIV-infected children receiving antiretroviral treatment now survive into adolescence. This is a period when young people experience puberty, shape their sexual identity and initiate their own social life. The aim of our analysis was to compare aspects of the sexual and reproductive health, social life and plans for the future of perinatally HIV-infected adolescents (PHIVAs) with a control group from the general population. We used data from the Teens Living with Antiretrovirals (TEEWA) survey carried out from 2010 to 2012 in Thailand among PHIVAs aged 12-19 years. Adolescents completed a self-administered questionnaire focusing on their daily life. Each PHIVA (case) was matched on sex, age and place of residence with a randomly selected adolescent from the general population (control). Analysis was stratified by gender and age; McNemar's test was used to compare cases and controls. A total of 1142 adolescents (571 cases and 571 controls) were included in the analysis, 42% boys and 58% girls. Cases experienced puberty delay compared to controls (p < 0.01). Cases and controls did not differ in terms of sex education, sexual initiation, romantic relationships or friendships, and risky behaviours. However, PHIVAs were less likely to attend the education system (p < 0.01), to plan for marriage (p < 0.01) or parenthood (p < 0.01). PHIVAs do not differ substantially from controls in terms of sexual and social life. Yet, affirmative action policies could help counterbalance their educational handicap. Provision of psychosocial support could enhance their ability to make informed decisions with regards to family formation.

Interferon-stimulated response element (ISRE)-binding protein complex DRAF1 is activated in Sindbis virus (HR)-infected cells.

To elucidate the host cell defense mechanisms in response to Sindbis viral infection, we have started to characterize interferon (IFN)-stimulated response element (ISRE)-binding proteins activated in infected cells that are involved in the transcriptional induction of IFN type I-inducible genes. Using electromobility shift assays (EMSA), we detected several protein complexes with a human IFN-stimulated gene 15 (ISG15) ISRE in extracts from virus-infected L929 cells that were absent in extracts from uninfected cells. Comigration with Newcastle disease virus-activated ISRE-binding complexes, ISRE-binding specificity, supershift experiments, and conditions of formation indicate that the complexes activated by Sindbis viral infection in L929 cells correspond to DRAF1 and ISG factor 3 (ISGF3). Transfection of L929 cells with poly rI:rC induced only ISGF3. DRAF1 could be detected in Sindbis virus-infected mouse embryo fibroblasts derived from IFNR type I and type II KO mice. Viral RNA synthesis is required for activation of DRAF1.

Experimental myelitis in BALB/cN and C57BL/6N mice caused by herpes simplex virus type 1 compared with herpes simplex virus type 2.

Intraperitoneal and footpad inoculations of herpes simplex virus type 1 (HSV) into BALB/cN (HSV-susceptible) and C57BL/6N (HSV-resistant) mice were carried out to induce experimental myelitis. Standard laboratory strains (McIntyre, F, RK, and recently Okinawa strain R1) were inoculated in mice. As a control, the HSV 2 standard laboratory strain SAV was also inoculated. The McIntyre strain was the most virulent, while the F strain was the least. RK and R1 were both moderately virulent. Myelitis was induced in BALB/cN mice after intraperitoneal and footpad inoculations of low to high doses of the McIntyre strain, and intraperitoneal inoculation of moderate and high doses of the RK and R1 strains. Symptoms of paraplegia of the hind legs and rectal and urinary incontinence were observed, but not until 3-5 hours before death. The symptoms caused by footpad inoculation were slightly different from those following intraperitoneal inoculation; rectal incontinence, in particular, was inconspicuous in the former. In the case of footpad inoculation of RK and R1, only one mouse inoculated with R1 showed symptoms and histology of myelitis. The F strain caused no symptoms. In the case of C57BL/6N mice, high dose intraperitoneal and footpad inoculations of the McIntyre strain also caused myelitis, and the symptoms were observed about 6-7 hours before death. In only one C57BL/6N mouse intraperitoneally inoculated with a high dose of R1 did symptoms appear about 6 hours before death. The same symptoms caused by intraperitoneal and footpad inoculations of HSV 2 (SAV) were observed more clearly and for a longer period (half to one day) than those caused by HSV 1 inoculation. Spinal cord necrosis was noted with McIntyre, RK and R1 inoculations, but it was not marked with randomly located foci, when compared with that caused by SAV. Further, the foci of necrosis in C57BL/6N mice were smaller than in BALB/cN mice, even when high dose McIntyre strain was used. Nuclear pyknosis and edema of the brain in the dead mice following HSV 1 inoculation were more marked than in those killed by SAV.

Isolation of Chlamydia trachomatis among women with symptoms of lower genital tract infection.

Isolation of chlamydia trachomatis from the endocervix using cyclohexamide-treated McCoy cells were done in order to estimate the prevalence rate of its infection among gynecologic out patients who had symptoms and/or signs of lower genital tract infection. There were 498 patients from May 1989 to July 1990. Eighty-six per cent of these patients were 25 years old or older. Most of them (63%) were agricultural employees. Ninety-three per cent were married and 78 per cent had less than or equal to seven yrs of education. Of 476 specimens, isolation rate of C. trachomatis was 7.8 per cent. Other infectious agents isolated by culture were Niesseria gonorrhea 4.8 per cent (24/497), Candida albicans 15.5 per cent (77/498) and Gardnerella vaginalis 6.08 per cent (303/498). Direct microscopy identified 9.4 per cent (32/380) of Trichomonas vaginalis. Multiple logistic regression analysis was able to identify four significant risk factors independently associated with isolation of C. trachomatis. These factors were N. gonorrheal cervicitis (odds ratio = 5.7, 95%, CI = 1.9, 17.0); age less than 25 yrs (odds ratio = 3.3, 95%, CI = 1.5, 7.4); G. vaginalis vaginitis (odds ratio = 3.0, 95%, CI = 1.3, 7.1) and purulent vaginal discharge (odds ratio = 2.5, 95%, CI = 1.5, 5.5).

Viral causes of unexplained anterior uveitis in Thailand.

AIMS: To assess the possible role of virus infection in patients with unexplained anterior uveitis (AU). METHODS: Intraocular fluid and plasma samples of 30 HIV-negative AU patients who were unresponsive or poorly responsive to topical steroid therapy were analyzed for nucleic acid of cytomegalovirus (CMV), herpes simplex virus (HSV), and varicella zoster virus (VZV) by real-time polymerase chain reaction (PCR) and for intraocular antibodies against these viruses by Goldmann-Witmer coefficient (GWC) analysis. Of these 30 cases, 21 were tested for rubella virus by GWC analysis, 16 of which also had PCR assessment of aqueous for rubella virus. RESULTS: Viral uveitis determined by either real-time PCR and/or GWC was documented in 20 out of 30 patients (67%). Of 30 paired samples tested by both methods for HSV, CMV, and VZV, 15 showed positive results (CMV (10), HSV (4), and VZV (1)). Real-time PCR was positive in 8/15 (53%), whereas GWC was positive in 10/15 (67%). Out of 10 CMV-positive patients, four had endotheliitis, two had Posner-Schlossman syndrome, and one Fuchs heterochromic uveitis syndrome (FHUS). Five out of 21 (24%) samples tested by GWC for Rubella virus were positive, three of which exhibited clinical features of FHUS. CONCLUSIONS: Our results indicate that CMV is a major cause of AU in Thailand and show that FHUS can be caused by both CMV and Rubella virus.

Uveitis in a tertiary ophthalmology centre in Thailand.

PURPOSE: To determine the aetiology and clinical characteristics of patients with uveitis in a tertiary ophthalmology centre in northern Thailand. METHODS: Standard ophthalmological examination and laboratory screening blood tests were performed in 200 consecutive new patients with uveitis. Patients were classified according to the location and aetiology of the uveitis. Specific clinical characteristics were recorded. DESIGN: Prospective case series. RESULTS: The case series included 106 male and 94 female patients with a mean age of 38 years. HIV-associated uveitis was noted in 31% (62/200), and included mostly patients with cytomegalovirus retinitis (85%, 53/62). In the non-HIV group, the most common anatomical type was anterior uveitis (34%, 47/138). Infectious uveitis was diagnosed in 22% (30/138) of non-HIV patients, and toxoplasmosis was the most common infection (12/138, 8.7%). The most common non-infectious clinical entities were Vogt-Koyanagi-Harada disease (20%, 22/108) and HLA-B27-associated acute anterior uveitis (9%, 10/108). CONCLUSIONS: The spectrum of uveitis in northern Thailand included 27% of HIV-infected patients with cytomegalovirus retinitis. Causes of non-HIV uveitis were similar to those often observed in the Far East, but the specific prevalences of these disorders were distinct from that found in India and Japan.

Restriction endonuclease cleavage analysis of herpes simplex virus type 2 from Chiang Mai, Thailand and Okinawa, Japan.

Genomic variations of herpes simplex viruses type 2 (HSV 2) isolated from Chiang Mai, Thailand and Okinawa, southernmost part of Japan were studied. The genomic polymorphism of 40 HSV 2 Chiang Mai strains and 10 HSV 2 Okinawan strains was analyzed by means of the variations of cleavage sites and electrophoretic mobilities of DNA fragments after digestion with 4 restriction endonucleases (RE (BamH I, Kpn I, EcoR I, and Bgl II)). Using the main 6 variable RE cleavage sites, HSV 2 strains were classified into 10 major groups. The strains categorized into group 1 and 9 were predominant in Chiang Mai. Groups 1, 3, 4, 5, 6 and 7 were found only in Chiang Mai, but contained only a few strains each. Groups 2 and 10 were found only in Okinawa, whereas groups 8 and 9 were found in both Chiang Mai and Okinawa.

Experimental myelitis caused by herpes simplex virus type 2 in C57BL/6N and BALB/cN mice.

Intraperitoneal and intracranial inoculation of herpes simplex virus type 2 (HSV 2) into BALB/cN and C57BL/6N mice was carried out to induce experimental myelitis. The myelitis was clearly observed in C57BL/6N mice following intraperitoneal inoculation. Within 24 hours before death, the mice showed urinary and rectal incontinence and paraplegia of the hind legs. Randomly distributed, severe necrosis was demonstrated in the spinal cord, mainly at the lower cord. In BALB/cN mice the clinical symptoms were not clearly observed, as the mice died shortly after their onset. Although spinal cord necrosis was more prominent in C57BL/6N mice than BALB/cN mice, brain necrosis was only found in the latter, and not in the former. Both strains of mouse showed marked nuclear pyknosis of the nerve cells and slight nuclear pyknosis of the astrocytes in the brain where HSV 2 antigen was demonstrated immunohistochemically. The antigen was also detected in the necrotic spinal cord. In contrast, intracranial inoculation of the virus into both strains did not cause myelitis. Spinal cord necrosis was not demonstrated and virus DNA was not detected, by PCR, in spinal cord samples. In the brain, however, the virus was demonstrated by both PCR and immunohistochemistry.

Pathologic studies and comparison of the virulence of herpes simplex virus type 2 from Okinawa, Japan and Chiang Mai, Thailand.

The virulence of four herpes simplex virus type 2 (HSV 2) strains (K1-K4) isolated in Okinawa, Japan was investigated, and compared with four strains (C1-C4) from Chiang Mai, Thailand and a standard laboratory strain SAV. Virulence was tested on BALB/c and C57/black mice. After viral inoculation intraperitoneally, the distribution with the passage of time of the virus in the brain and other organs was also studied using the polymerase chain reaction (PCR) method and immunohistochemistry. Generally, Okinawan HSV 2 (K1, K3 and K4) were less virulent than Chiang Mai strains (C1-C4). Among the Okinawan strains, K2 was the most virulent, but slightly less so than C3 and C4. All four Chiang Mai strains (C1-C4) and one Okinawan strain (K2) were more virulent than SAV strain. The virulence of K3 was very weak and no animals died from the intraperitoneal inoculation. In the brain, viral DNA from each strain was demonstrated at 1-9 days after inoculation by the PCR method. However, K3 strain was detected in the brain only between one day and 3 days after virus inoculation, and not after day 5. Immunohistochemically, the virus antigen was first demonstrated around the 3rd ventricle at one day after viral inoculation, then strongly at the ventral hypothalamus and the temporal lobe at 3 days after viral inoculation, and slightly in the frontal lobe, hippocampus, pons and cerebellum (on day 5 after inoculation). Furthermore, in Kupffer cells in the liver and macrophages in the spleen, numerous viral antigens were demonstrated from one to 9 days after viral inoculation.(ABSTRACT TRUNCATED AT 250 WORDS)