HLA class II diversity in HIV-1 uninfected individuals from the placebo arm of the RV144 Thai vaccine efficacy trial.

The RV144 HIV vaccine trial in Thailand elicited antibody responses to the envelope of HIV-1, which correlated significantly with the risk of HIV-1 acquisition. Human leukocyte antigen (HLA) class II molecules are essential in antigen presentation to CD4 T cells for activation of B cells to produce antibodies. We genotyped the classical HLA-DRB1, DQB1, and DPB1 genes in 450 individuals from the placebo arm of the RV144 study to determine the background allele and haplotype frequencies of these genes in this cohort. High-resolution 4 and 6-digit class II HLA typing data was generated using sequencing-based methods. The observed diversity for the HLA loci was 33 HLA-DRB1, 15 HLA-DQB1, and 26 HLA-DPB1 alleles. Common alleles with frequencies greater than 10% were DRB1*07:01, DRB1*09:01, DRB1*12:02, DRB1*15:02, DQB1*02:01/02, DQB1*03:01, DQB1*03:03, DQB1*05:01, DQB1*05:02, DPB1*04:01:01, DPB1*05:01:01, and DPB1*13:01:01. We identified 28 rare alleles with frequencies of less than 1% in the Thai individuals. Ambiguity for HLA-DPB1*28:01 in exon 2 was resolved to DPB1*296:01 by next-generation sequencing of all exons. Multi-locus haplotypes including HLA class I and II loci were reported in this study. This is the first comprehensive report of allele and haplotype frequencies of all three HLA class II genes from a Thai population. A high-resolution genotyping method such as next-generation sequencing avoids missing rare alleles and resolves ambiguous calls. The HLA class II genotyping data generated in this study will be beneficial not only for future disease association/vaccine efficacy studies related to the RV144 study, but also for similar studies in other diseases in the Thai population, as well as population genetics and transplantation studies.

Integrated systems approach defines the antiviral pathways conferring protection by the RV144 HIV vaccine.

The RV144 vaccine trial showed reduced risk of HIV-1 acquisition by 31.2%, although mechanisms that led to protection remain poorly understood. Here we identify transcriptional correlates for reduced HIV-1 acquisition after vaccination. We assess the transcriptomic profile of blood collected from 223 participants and 40 placebo recipients. Pathway-level analysis of HIV-1 negative vaccinees reveals that type I interferons that activate the IRF7 antiviral program and type II interferon-stimulated genes implicated in antigen-presentation are both associated with a reduced risk of HIV-1 acquisition. In contrast, genes upstream and downstream of NF-κB, mTORC1 and host genes required for viral infection are associated with an increased risk of HIV-1 acquisition among vaccinees and placebo recipients, defining a vaccine independent association with HIV-1 acquisition. Our transcriptomic analysis of RV144 trial samples identifies IRF7 as a mediator of protection and the activation of mTORC1 as a correlate of the risk of HIV-1 acquisition.

Declining prevalence of HIV-1 infection in young Thai men.

OBJECTIVE: To evaluate trends in HIV-1 seroprevalence in Thailand. DESIGN: HIV-1 serosurvey of successive cohorts of young Thai men entering service with the Royal Thai Army (RTA) between November 1989 and November 1994. METHODS: In November 1989, the RTA Medical Department began routine HIV-1-antibody screening of men who were selected by lottery for conscription. Between November 1989 and November 1994, 311,108 young men were screened at induction. Demographic data were collected between November 1991 and May 1993 and again in November 1994. RESULTS: The seroprevalence of HIV-1 among conscripts nationwide increased rapidly from 0.5% in 1989 to 3.5% in 1992 and reached 3.7% in 1993. In 1994, the overall prevalence decreased to 3.0%. The decrease was greatest in the upper North (from 12.4% in 1992 to 7.9% in 1994), where the prevalence has been the highest. However, decreases were observed in men from all regions of residence in the country, from both rural and urban areas, and at all educational levels. CONCLUSIONS: The decline in prevalence suggests declining incidence and that HIV control programs in Thailand are having an impact on the HIV epidemic.

PIP: Since 1989, the Royal Thai Army has screened new conscripts for human immunodeficiency virus (HIV)-1 infection. An analysis of HIV test results for the 311,108 young men entering the Army between November 1989 and November 1994 indicates that the Thailand Government's acquired immunodeficiency syndrome (AIDS) prevention program has had a positive impact on high-risk behaviors. The HIV seroprevalence increased from 0.5% in 1989 to 3.5% in 1992 and 3.7% in 1993, but then fell to 3.0% in 1994. The prevalence in the North--the region with the highest rate--peaked at 7.5% in 1992, then declined to 5.1% in 1994. This pattern of decline was observed in all regions of residence and at all educational levels. The only exception was a slight increase (from 4.1% in 1992 to 5.0% in 1994) in seroprevalence among the 4.2% of conscripts aged 22-29 years. Condom use, less frequent visits to commercial sex workers, and decreasing rates of sexually transmitted diseases are assumed to be the factors contributing to the decline in HIV infection.

Incidence of HIV-1 infection among young men in Thailand.

Royal Thai Army (RTA) enlistees were tested for HIV-1 seropositivity prospectively in order to explore their feasibility as a cohort in an HIV-1 preventive vaccine efficacy trial. The 17,615 seronegative enlistees, virtually all 21-year-old men, contributed 10,409 person-years (p-y) of follow-up. Cohorts were enlisted in November 1991 and May 1992 from northern Thailand and Bangkok. The follow-up rate was 50%, with loss to follow-up significantly associated with location of the base, marital status, and educational level. Seroincidence was 0.5/100 p-y for recruits stationed in Bangkok, 1.0/100 p-y in the lower north, and 3.2/100 p-y in the upper north. In a multiple regression model, the young man's birthplace was strongly associated with risk of infection, suggesting that transmission occurred during leave as well as during duty. Incidence rates were significantly lower in those who were married at the time of enlistment and in those with > or = 10 years of education. The seroincidence rates among recruits stationed in the upper north support vaccine trial feasibility, but follow-up rates need to be improved.

An isoelectric focusing overlay study of the humoral immune response in Theiler's virus demyelinating disease.

Oligoclonal immunoglobulin G (IgG) bands are a frequent feature of inflammatory diseases of the central nervous system (CNS). In multiple sclerosis (MS), cerebrospinal fluid (CSF) oligoclonal IgG bands are a potential clue to the pathogenesis of the disease; however, their particular antigenic target is unknown. We sought to characterize the IgG response in an experimental CNS persistent demyelinating infection by isoelectric focusing (IEF) studies of serum and CSF from mice infected with Theiler's murine encephalomyelitis virus (TMEV). Following IEF, we used a new technique in order to identify TMEV-specific antibodies; focused immunoglobulins were blotted onto nitrocellulose paper which was then overlaid with radiolabeled virus. Autoradiograms showed that most of the TMEV antibody was locally synthesized within the CNS since CSF, but not serum, TMEV antibody had an anodal distribution. CSF IEF TMEV antibody spectrotypes were very similar, presumably because the CSFs were collected from the same inbred mouse strain. CSF TMEV antibody displayed less restricted heterogeneity than the very restricted cathodal CSF oligoclonal IgG bands seen in MS. The new IEF immunoblotting antigen overlay technique will be a powerful detection system to probe for the antigenic target against which MS CSF IgG may be directed.

Diversity of envelope glycoprotein from human immunodeficiency virus type 1 of recent seroconverters in Thailand.

The envelope-coding sequence of human immunodeficiency virus type 1 (HIV-1) was determined for 11 Thai seroconverters between 1995 and 1996. On the basis of the env sequences, all subjects were infected with HIV subtype E. Compared with the interpatient protein diversity among HIV-1 Thai reference sequences from 1990 to 1992 (4.4%), the diversity among the 1995-1996 seroconverters was approximately double (9.5%). The tetrapeptide tip of the V3 loop was invariant for 10 of the 11 seroconverters, and identical to that observed in sequences derived from the 1990-1992 group. However, in the V3 region, sequences from 2 of the 11 subjects demonstrated more than 5 amino acid changes relative to the reference strains. This may represent the "aging" of the HIV epidemic seen in other endemic regions. These findings may have substantial implications for vaccine development and evaluation for both HIV antibody and cytotoxic T lymphocyte repertoire recognition.

A comparative study of the impact of HIV infection on natural killer cell number and function in Thais and North Americans.

Innate immunity may play a role in preventing HIV infection and progression to AIDS. Most studies of natural killer (NK) cell function have been conducted in populations with different HLA allele frequencies and HIV subtypes than those found in Southeast Asia. NK cell number and function, defined as CD3- cells expressing CD16+/CD56+ and the ability to lyse K562 cells, were enumerated in 42 HIV-seronegative Thais and 20 HIV-seronegative North Americans. The number and percentage of NK cells were similar for both groups, but cytotoxicity function expressed as lytic units (LU20) of NK cells was significantly greater in the Thai subjects compared with the North American subjects (p = 0.004). Comparisons were also conducted between the HIV-seronegative groups and HIV-infected subjects from both Thailand and North America. NK cell number and function were not significantly different between the Thai HIV-seronegative and -seropositive groups. However, the comparison between the North American HIV-seronegative and -seropositive subjects demonstrated profound impairment of NK cell number, percentage, and function (p < 0.001). Matching the Thai and North American HIV-infected subjects on CD4+ cell count revealed higher NK number and function in the Thai subjects (p < 0.001). The study indicates that NK function in both HIV-seronegative and -seropositive Thais is elevated relative to similar groups in North America.

Rapid detection and identification of dengue viruses by polymerase chain reaction (PCR).

A polymerase chain reaction (PCR) method using sets of newly designed primers for rapid detection and simultaneous identification of dengue virus serotypes was developed and tested. The test is based on two sets of primers specific within the envelope (E) and non-structural (NS1) regions of the dengue-virus genome. Two sets of universal primers that bind to two target sequences which are shared by all the four serotypes of the virus within the E and NS1 regions are used. The resulting products are further amplified by another pair of inner or nested universal primers, which also bind to another set of shared sequences within the E and NS1 regions, respectively. The nested PCR of both the E and NS1 regions can detect dengue virus of all the four serotypes at a sensitivity of 1 plaque forming unit (pfu) or less. For the identification of serotypes, a mixture of four pairs of serotype-specific primers, specific to the E region, was used. The primers have been designed to bind to serotype specific sequences within the regions flanked by the outer universal primers, and giving the amplified products of different sizes, each corresponds to one particular serotype (405 bp for Den1, 346 bp for Den2, 196 bp for Den3, and 143 bp for Den4). A protocol has been developed and successfully applied to detect dengue virus in cell-culture supernatants and patients sera. The technique is simple and rapid, capable of not only detecting the dengue virus but also identifying the serotypes of the virus in clinical specimens.

Flow cytometric detection of intracellular cytokines in peripheral blood of HIV-1 infected Thai children.

The objective of this study was to determine changes in Th1/Th2 cytokine production at the cellular level which occur during the progression of HIV-1 subtype E infection in Thai children born to HIV-1 subtype E infected mothers. Mitogen stimulated whole blood cultures from 12 uninfected and 27 HIV-1 subtype E infected Thai children were stained intracellularly with fluorescein labelled monoclonal antibodies against Interleukin (IL)-2 and IFN-gamma (Th1 cytokines) and IL-4 (Th2 cytokine). Additionally, co-staining of CD4+ and CD8+ T cells was performed. Results were analyzed by two and three color flow cytometry. The percentage of IFN-gamma expressing cells in CD4+ T cells was increased in HIV-1 subtype E infected Thai children with mild and moderate immunosuppression (Immunological categories 1 + 2, Centers for Diseases Control and Prevention (CDC) staging system, 1994). The percentages of IFN-gamma expression was continuously enhanced accompanied by remaining preserved in the proportion of IL-2 producing T cells in HIV-1 subtype E infected Thai children with severe immunosuppression (Immunological category 3, CDC staging system, 1994). The percentages of IFN-gamma expression was continuously augmented whereas the proportion of IL-2 producing T cells remained unchanged in HIV-1 subtype E infected Thai Children with severe immunosuppression (immunological category 3, CDC staging system, 1994). The percentage of Th2 cytokine producing cells within the CD4+ ad CD8+ T cells increased in HIV-1 subtype E infected individuals and showed a significant difference in HIV-1 subtype E infected Thai children with AIDS compared with uninfected infants. These results suggest that in vertically acquired HIV-1 infection with severe immunosuppression, the percentages of IL-2 producing CD4+ T cell was consistent but the percentages of IL-4 and IFN-gamma producing cell were increased. Similar results were found for CD8+ T cells in which IL-4 producing cells were increased in conjunction with a remaining in the number of IL-2 producing cells in HIV-1 subtype E infected Thai children. Thus, changes in the Th1 and Th2 cytokine pattern during HIV-1 infection may contribute to the prognosis of HIV disease in children.

DTH responsiveness of HIV-infected Thai adults.

A study was carried out in Thailand to determine the frequency of reactivity to delayed-type hypersensitivity (DTH) skin tests used for the staging of HIV patients in the United States. A four-antigen panel which included tetanus toxoid (1:10), Candida (1:10), mumps and Trichophyton antigens was assessed in 221 adult subjects from across the full immunological spectrum of HIV disease. Complete anergy was found in 38 per cent of 73 subjects with CD4 counts of 0-200 cells/ml and in 6 per cent of 78 subjects with 201-400 cells/ml. Partial anergy (response to 1 of 4 antigens) was found in 26 per cent of the 0-200 cell/ml group and decreased progressively with increasing CD4 cell count. Results suggested that a 3-member recall antigen panel would provide nearly all the clinically useful information gained by the more standard 4-member panel. In conclusion, DTH skin testing was confirmed to provide a method of assessing the integrity of cellular immune function of HIV-infected Thai adults which correlated with disease progression.

Localization of a neutralization site of Theiler's murine encephalomyelitis viruses.

Theiler's murine encephalomyelitis viruses (TMEV) are picornaviruses that produce enteric and neurological diseases in mice. Subgroup TO strains of TMEV cause persistent infections with demyelination, while subgroup GDVII strains neither persist nor demyelinate. We produced neutralizing monoclonal antibodies (mAbs) to clarify the mechanisms of persistence and demyelination. Some of the neutralizing mAbs reacted with isolated VP1 on Western blots, while others were conformation specific. The neutralization site for the former TMEV mAbs was on the VP1 trypsin cleavage site of the intact virion. The neutralization site for the conformation-specific mAbs was distinct and was not affected by trypsin. Trypsin treatment of subgroup TO strains increased their infectivity for L cells, whereas the infectivity of subgroup GDVII strains was decreased by trypsin treatment. Subpopulations of virus in subgroup TO-infected tissue culture cells and in infected mouse brain homogenates contained VP1-cleaved virus; this VP1-cleaved virus gave rise to a large persistent fraction in neutralization tests when it was reacted with VP1-specific mAbs. These findings have implications regarding the pathogenesis of subgroup TO demyelinating disease. TMEV VP1 cleavage may be important for virus persistence because of disruption of a major neutralization epitope. The change in virus surface structure caused by VP1 cleavage may affect cell binding and lead to altered cytotropism. Immunocytes, which have been implicated in subgroup TO demyelination, may provide a source for proteases for VP1 cleavage.

Neutralizing monoclonal antibodies to Theiler's murine encephalomyelitis viruses.

Theiler's murine encephalomyelitis viruses (TMEV) are serologically related picornaviruses which cause both enteric and neurological disease in mice. The biological activities of TMEV vary between the two different TMEV subgroups (TO and GDVII) and with different passage histories of the same TMEV strain (e.g., mouse brain-passed versus tissue culture-passed DA strain of the TO subgroup). We raised neutralizing monoclonal antibodies (mAbs) against tissue culture-passed DA and GDVII strains of TMEV. We produced two mAbs against the DA strain which neutralized all members of the TO subgroup, but not the GDVII subgroup strains (GDVII and FA); these two DA mAbs reacted similarly with both mouse brain-passed DA and tissue culture-passed DA. Of six neutralizing GDVII mAbs, four reacted only to GDVII and FA, whereas two neutralized TO strains as well. These mAbs demonstrate the presence of TMEV group-specific as well as subgroup-specific neutralization and substantiate the division of TMEV into two distinct subgroups. On Western immunoblots one of the two DA mAbs reacted against isolated DA VP1, two GDVII mAbs (which were TMEV group specific) reacted against isolated GDVII VP1 and DA VP1, and the other DA mAb and four other GDVII mAbs required an intact virion conformation for reactivity. An analysis of the epitopes recognized by these mAbs may elucidate sites important in TMEV biological activities.

Nucleotide sequence of the virulent SA-14 strain of Japanese encephalitis virus and its attenuated vaccine derivative, SA-14-14-2.

The attenuated SA-14-14-2 strain of Japanese encephalitis (JE) virus has been used to immunize people in the People's Republic of China. Oligonucleotide fingerprints of the parent SA-14 and vaccine strain indicate that multiple genetic changes occurred during attenuation of the virus. We have cloned and sequenced the genomes of both the virulent SA-14 and attenuated SA-14-14-2 viruses to define molecular differences in the genomes. Forty-five nucleotide differences, resulting in 15 amino acid substitutions, were found by comparing sequences of the SA-14 and SA-14-14-2 genomes. Transversion of U to A occurred at position 39 in the 5'-noncoding region of SA-14-14-2 and another SA-14 vaccine derivative SA-14-5-3. A single nucleotide change in the capsid gene of SA-14-14-2 altered a single amino acid which changed its predicted secondary structure. A silent nucleotide change was found in the prM gene sequence and the M-protein was unchanged. There are seven nucleotide differences, resulting in five amino acid changes, in the E glycoprotein sequence of the two viruses. Nine amino acid differences were found in the nonstructural proteins of SA-14 and SA-14-14-2: one in NS2A, two in NS2B, three in NS3, one in ns4a, and two in NS5. A single nucleotide change at position 10,428 in the 3'-noncoding region is vaccine virus-specific. The nucleotide and deduced amino acid sequences of the vaccine strain SA-14-14-2, the parent virus SA-14, and virulent strains JaOArS982 and Beijing-1 have been compared and are highly conserved.

Willingness to participate in HIV-1 vaccine trials among young Thai men.

OBJECTIVES: Willingness to participate in HIV-1 vaccine trials and associated factors were investigated in a sample of 2670 Royal Thai Army conscripted recruits. METHODS: Self administered questionnaires were used. Data were collected during the final visit of a longitudinal cohort study of HIV-1 epidemiology. Cross sectional analysis of data from this visit was performed. RESULTS: 32% of the respondents reported they would "definitely" join an HIV-1 vaccine trial. Greater willingness was associated with perceived risk of HIV-1 infection and a desire to help Thai society, although tangible incentives and intentions to reduce condom use in a vaccine trial also were associated with increased willingness. Concerns about physical harm and anticipated social pressure from family not to join were the most substantial impediments to willingness. Concerns about "social harm" (for example, participation would give appearance of having AIDS virus, a partner might refuse sex) also appeared to inhibit interest in joining trials and approached significance. CONCLUSIONS: Willingness to participate was somewhat greater than in other investigations of non-injection drug user (IDU) cohorts in Thailand, with fewer concerns expressed about physical harm. Motivations appear to involve tradeoffs among perceived risk, anticipated social pressure, altruism, and tangible rewards. The absence of significant problems associated with vaccine trials to date, along with the presence of educational interventions in the study may help explain the lower level of concerns here relative to other Thai studies.

HIV viral load in Thai men and women with subtype E infections.

The assessment of potential "breakthrough infections" in HIV vaccine trials requires knowledge of viral load in unvaccinated persons. Therefore, HIV-1 RNA was quantitated in plasma from Thai adults with subtype E infections. RNA was detectable (> or =500 copies/ml) in 93% of 255 specimens, with a mean (standard deviation) value of 4.09 (0.88) log copies/ml. The concentration of RNA was directly related to the presence of AIDS-defining illnesses, inversely related to CD4 count, and independent of gender after adjustment for CD4 count.

Motivation, recruitment, and screening of volunteers for a phase I/II HIV preventive vaccine trial in Thailand.

Data from recruitment and screening for a phase I/II preventive HIV-1 vaccine trial in Thailand were evaluated with respect to correlates of participation at each phase. Correlates included demographic variables, motivation for interest in the trial, and factors related to communication and contact. Participants were recruited at two sites through varied methods. The majority of prescreenees reported altruistic motives for interest in the trial and blood donors emerged as a group that may have been particularly altruistic. Findings indicated site differences in attrition during recruitment and screening, but not in enrollment into the vaccine trial. Blood donation and willingness to be contacted by phone at home were significantly related to making and keeping screening appointments.

PIP: The issue of recruitment of volunteers for trials of an HIV preventive vaccine has raised concerns, especially in developing countries, about motivation, the potential for coercion, informed consent, unblinding, and the social consequences of vaccine-induced seropositivity. The present study evaluated factors related to the recruitment and retention of volunteers for a double-blind, placebo-controlled phase I/II preventive HIV vaccine trial conducted at two medical centers in Thailand (Bangkok and Chiang Mai). 217 men and women responded to calls for volunteers, 124 scheduled a screening appointment, and 104 appeared for the appointment; 54 actually enrolled. 56.2% of prescreenees expressed altruistic motives (desire to benefit Thai society or contribute to stopping the AIDS epidemic) for their interest in the study. Multivariate analysis indicated that willingness to schedule an appointment was significantly associated with a history of blood donation and a willingness to be contacted by the project at home by phone. Actual attendance at the appointment was significantly associated only with blood donation history. None of the factors examined--motives, willingness to be contacted by phone or mail, site, demographics, and blood donation history--was related to whether screened volunteers were deemed eligible and enrolled. Only 2 volunteers dropped out of the study, both at an early point. The presence of multiple stages of recruitment allows potential volunteers an opportunity to reevaluate their willingness to participate and seems to ensure a high level of commitment.

Relationship of Theiler's murine encephalomyelitis viruses to the cardiovirus genus of picornaviruses.

Sequence analysis of VP1 in the DA strain of Theiler's murine encephalomyelitis viruses (TMEV) showed that 13 of the first 23 N-terminal amino acids were identical to those in the corresponding protein of encephalomyocarditis virus. There was little similarity to the corresponding VP1 sequences of poliovirus types 1, 2 and 3, coxsackievirus B3, human rhinoviruses 2 and 14, human hepatitis A virus or foot-and-mouth disease virus. These results, as well as serological relationships detected by immunoblotting, suggest that the TMEV are more closely related to the cardioviruses than to the enteroviruses with which they are presently classified. This newly recognized relationship suggests potential for recombinant infectious cDNA studies between TMEV and cardioviruses.

Cross-clade cytotoxic T cell response to human immunodeficiency virus type 1 proteins among HLA disparate North Americans and Thais.

A globally effective vaccine will need to elicit cytotoxic T lymphocytes (CTL) capable of recognizing diverse human immunodeficiency virus type 1 (HIV-1) clades. Study of the cellular immune responses of HIV-1-infected persons may allow predictions to be made regarding useful vaccine antigen components. The frequency and magnitude of CTL responses to clade E and B Gag, Pol-RT, Env, and Nef proteins were compared in 12 HLA-characterized, clade E-infected Thais and in 10 clade B-infected North Americans using vaccinia recombinant constructs for protein expression. While responses were detected against all proteins, they were most frequent and cross-reactive to Gag in both groups. Pol-RT was recognized less frequently in Thais than North Americans. Cross-clade protein recognition was common but not uniformly present among these HLA-disparate individuals. Population-specific CTL data are needed to adequately prepare for vaccine trials outside of North America and Europe.