Background: Sexually transmissible infection (STI) rates in Thailand declined from 1986 to 1994, but levelled off until 2002. This study documents the distribution of STI cases attending major treatment venues and the quality of treatment in a rural area. Methods: A cross sectional study was conducted in January and June 2001 in all 42 health-care facilities in the study district, including the hospital STI and outpatient clinics, private clinics, local health centres and pharmacies. Quality of care was assessed by documenting appropriate syndromic treatment according to the World Health Organization Syndromic Case Management Guidelines. Results: Over half of STI patients (60%) sought treatment from pharmacies (35%) and health centres (25%), the facilities least capable of accurately diagnosing and treating STI. Only 0–59% were adequately treated. Conclusions: The quality of services needs to be improved and innovative strategies developed and implemented to address the problems of acceptability, stigmatisation, access and quality of STI services in Thailand.
Abstract In 2019, the National Institutes of Health combined the Multicenter AIDS Cohort Study (MACS) and the Women’s Interagency HIV Study (WIHS) into the MACS/WIHS Combined Cohort Study (MWCCS). In this paper, participants who made a study visit during October 2018–September 2019 (targeted for MWCCS enrollment) are described by human immunodeficiency virus (HIV) serostatus and compared with people living with HIV (PLWH) in the United States. Participants include 2,115 women and 1,901 men with a median age of 56 years (interquartile range, 48–63); 62% are PLWH. Study sites encompass the South (18%), the Mid-Atlantic/Northeast (45%), the West Coast (22%), and the Midwest (15%). Participant race/ethnicity approximates that of PLWH throughout the United States. Longitudinal data and specimens collected for 35 years (men) and 25 years (women) were combined. Differences in data collection and coding were reviewed, and key risk factor and comorbidity data were harmonized. For example, recent use of alcohol (62%) and tobacco (28%) are common, as are dyslipidemia (64%), hypertension (56%), obesity (42%), mildly or severely impaired daily activities (31%), depressive symptoms (28%), and diabetes (22%). The MWCCS repository includes serum, plasma, peripheral blood mononuclear cells, cell pellets, urine, cervicovaginal lavage samples, oral samples, B-cell lines, stool, and semen specimens. Demographic differences between the MACS and WIHS can confound analyses by sex. The merged MWCCS is both an ongoing observational cohort study and a valuable resource for harmonized longitudinal data and specimens for HIV-related research.
Non-Hodgkin's B cell lymphoma (NHL) is a common cancer in HIV infection. Many NHL are thought to result from errors in class switch recombination and/or somatic hypermutation, processes that occur in germinal center B cells, and require the activity of activation induced cytidine deaminase (AID). Since NHL is a common cancer in HIV infection, and expression of AID could contribute to the development of NHL, we hypothesized that AID expression would be elevated in those who went on to develop AIDS-associated NHL (AIDS-NHL). AID mRNA levels were measured by TaqMan RT-PCR in peripheral blood mononuclear cells, obtained prior to AIDS-NHL diagnosis, from 16 HIV-infected subjects who developed AIDS-NHL, and from control subjects (AIDS but no NHL, and HIV-negative subjects). PBMC AID expression was markedly elevated in those who developed AIDS-NHL, when compared to AIDS and HIV-negative controls. Additionally, AID expression was seen to differ depending on NHL subtype, with the highest levels of expression seen in those who developed Burkitt's lymphoma.
Abstract The reliability of self-reports of sexual acts and sexually transmitted disease symptoms was compared among 199 food market workers in an eastern coastal city in China using audio computer-assisted self-interviewing (ACASI) and computer-assisted personal interview (CAPI). Two assessments (ACASI and CAPI) were evaluated with each participant; 100 participants were interviewed with ACASI first, followed by CAPI, and 99 participants were interviewed by CAPI first, followed by ACASI. McNemar tests showed that participants were significantly more likely to report that they had engaged in lifetime sexual intercourse when using a CAPI interview than an ACASI interview. There was no significant difference between CAPI and ACASI in reports of the number of lifetime sexual partners and two measures of sexually transmitted disease. Participants with less education were more likely to give inconsistent responses than participants with more education and older participants were more likely to have discrepancies in their sexual behavior responses than younger participants. ACASI is not necessarily a better mode of data collection than CAPI for sensitive behavioral measures among urban market workers in China.
The objective of this study was to compare the time to AIDS and to death between men receiving zidovudine therapy before or not before the diagnosis of AIDS. For the time to AIDS comparison, 821 men receiving zidovudine therapy before the diagnosis of AIDS were pair matched with men who did not receive zidovudine therapy until after diagnosis on their CD4 cell count (+/- 75 cells/mm3), haemoglobin level (+/- 0.75 g/dl), number of clinical symptoms and study visit at the time of initiation of zidovudine therapy and were monitored for a median of 2.08 years. For the time to death comparison, 186 men who received zidovudine therapy prior to AIDS diagnosis were pair matched on the same variables to men who received zidovudine therapy only after the AIDS diagnosis, and were monitored for a median of 2.88 years. Only men with < 350 CD4 cells/mm3 who received zidovudine therapy prior to AIDS diagnosis remained AIDS free significantly longer than their pair match who did not (P < 0.0001). The median extension of time to AIDS was 0.61 years for men with < 200 CD4 cells/mm3 and 1.13 years for men with 200-349 CD4 cells/mm3. Cox regression analysis showed a significantly increased time to AIDS for the men with < 350 CD4 cells/mm3, both before and after adjustment for the use of prophylactic drugs against Pneumocystis carinii pneumonia. No difference was seen in the time to death between men receiving zidovudine therapy before or only after AIDS diagnosis. Zidovudine treatment of asymptomatic HIV-1-infected men provides significant benefit to men with < 350 CD4 cells/mm3 by extending AIDS-free time, but does not extend survival. The analytical technique used is applicable to other observational studies of treatment.
Objective Examine prospective relationships between erectile dysfunction (ED) drugs and CD4 and CD8 T-cells, and immune markers among men who have sex with men (MSM).Methods Data from Multicenter AIDS Cohort Study, an observational prospective cohort study, with semiannual follow-ups conducted in four U.S. centers from 1998 onwards was used. Marginal structural models using g-computation were fitted to estimate the mean differences for the effects of self-reported ED drug use on CD4 and CD8 T-cell outcomes and immune biomarkers.Results Total of 1,391 men with HIV (MWH) and 307 men without HIV (MWOH) was included. Baseline mean CD4 cell count among MWH and MWOH was 499.9 and 966.7 cells/μL, respectively. At baseline, 41.8% of MWH were virally suppressed. ED drug users reported a mean of 44.4 months of exposure to ED drugs. ED drug use was associated with increased CD4 cell outcomes among MWH but not MWOH. Mean differences in CD4 cell counts after 1 year of ED drug use was 57.6 cells/μL and increased to 117.7 after 10 years among MWH. CD8 counts were higher in ED drug users among MWH over 10 years than non-users; no consistent differences were found among MWOH. ED drug use appeared to reduce immune marker levels, such as IL-6 and increase markers, such as IL-10. We observed similar effects of ED drug use on biomarker levels among MWOH.Conclusion Long-term use of ED drugs do not adversely affect immune function among MWH or MWOH. Future studies on the relationships between different types of ED drugs and effects on T-cell subtypes are warranted.
