Last data update: Apr 22, 2024. (Total: 46599 publications since 2009)
Records 1-11 (of 11 Records) |
Query Trace: Thienkrua W [original query] |
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Why we need pre-exposure prophylaxis: incident HIV and syphilis among men, and transgender women, who have sex with men, Bangkok, Thailand, 2005-2015
Holtz TH , Wimonsate W , Mock PA , Pattanasin S , Chonwattana W , Thienkrua W , Sukwicha W , Curlin ME , Chitwarakorn A , Dunne EF . Int J STD AIDS 2019 30 (5) 956462418814994 We describe incident human immunodeficiency virus (HIV) and syphilis trends in men who have sex with men (MSM) and transgender women (TGW) presenting for HIV voluntary counseling and testing (VCT) services and sexually transmitted infection (STI) management at the Silom Community Clinic, Bangkok, Thailand. Clients underwent rapid HIV testing and syphilis rapid plasma reagin (RPR) testing. For incidence analysis, we included clients with >1 follow-up visit. Initial negative HIV with subsequent positive HIV defined incident HIV infection; incident syphilis infection was defined as negative RPR followed by positive RPR (titer >/=1:8) and confirmatory anti- Treponema pallidum antibodies. Calculation of incidence using Poisson regression assumed a uniform probability distribution throughout the seroconversion interval. From 15 September 2005 to 31 December 2015, we tested 10,158 clients for HIV and 10,324 for syphilis. Overall, 7109 clients tested HIV-seronegative and contributed 7157 person-years (PY). Three-hundred forty-seven incident HIV infections resulted in an incidence rate of 4.8 per 100 PY (95% confidence interval [CI] 4.4-5.4). We found an inverted U-shape trend of HIV incidence over time with a peak of 6.4 per 100 PY in quarter 2/2011 ( p < 0.01) (Poisson with RCS function, p = 0.001). Overall, 8713 clients tested seronegative for syphilis and contributed 8623 PY. The incidence of syphilis infection was 4.4 per 100 PY (95% CI 3.9-4.8). Despite an apparent decline in HIV incidence among MSM and TGW attending VCT services, syphilis incidence rose and remained high. Evaluating temporal trends of HIV and syphilis incidence provides an opportunity to evaluate epidemic trajectories and target limited program funding. We recommend focused HIV and STI prevention interventions for MSM in Bangkok. |
Estimating recent HIV incidence among young men who have sex with men: Reinvigorating, validating and implementing Osmond's algorithm for behavioral imputation
van Griensven F , Mock PA , Benjarattanaporn P , Premsri N , Thienkrua W , Sabin K , Varangrat A , Zhao J , Chitwarakorn A , Hladik W . PLoS One 2018 13 (10) e0204793 HIV incidence information is essential for epidemic monitoring and evaluating preventive interventions. However, reliable HIV incidence data is difficult to obtain, especially among marginalized populations, such as young men who have sex with men (YMSM). Here we evaluate the reliability of an alternative HIV incidence assessment method, behavioral imputation, as compared to serologically estimated HIV incidence. Recent HIV incidence among YMSM (aged 18 to 21 and 18 to 24 years) enrolled in a cohort study in Bangkok from 2006 to 2014 was estimated using two mid-point methods for seroconversion: 1) between age of first anal intercourse and first HIV-positive test (without previous HIV-negative test) (behavioral imputation) and 2) between the date of last negative and first positive HIV test (serological estimation). Serologically estimated HIV incidence was taken as the "gold standard" to evaluate between-method agreement. At baseline, 314 YMSM age 18 to 21 years accumulated 674 person-years (PY) of follow-up since first anal intercourse. Considering that 50 men had prevalent HIV infection, the behaviorally imputed HIV incidence was 7.4 per 100 PY. Of the remaining 264 HIV-negative men, 54 seroconverted for HIV infection during the study, accumulating 724 PY of follow-up and a serologically estimated HIV incidence of 7.5 per 100 PY. At baseline, 712 YMSM age 18 to 24 years (including 18 to 21-year-old men analyzed above) accumulated 2143 PY of follow-up since first anal intercourse. Considering that 151 men had prevalent HIV infection, the behaviorally imputed HIV incidence was 7.0 per 100 PY. Of the remaining 561 HIV-negative men, 125 seroconverted for HIV infection during the study, accumulating 1700 PY of follow-up and a serologically estimated HIV incidence of 7.4 per 100 PY. Behavioral imputation and serological estimation are in good agreement when estimating recent HIV incidence in YMSM. |
The finding of casual sex partners on the internet, methamphetamine use for sexual pleasure, and incidence of HIV infection among men who have sex with men in Bangkok, Thailand: an observational cohort study
Piyaraj P , van Griensven F , Holtz TH , Mock PA , Varangrat A , Wimonsate W , Thienkrua W , Tongtoyai J , McNamara A , Chonwattana W , Nelson KE . Lancet HIV 2018 5 (7) e379-e389 BACKGROUND: The finding of casual sex partners on the internet and methamphetamine use have been described as risk factors for HIV infection in men who have sex with men (MSM). However, the interplay between these factors has not been studied prospectively in one design. This study aims to determine the associations between finding casual sex partners on the internet and incident methamphetamine use and HIV infection. METHODS: In this observational cohort study of Thai MSM, we recruited Bangkok residents aged 18 years or older with a history of penetrative male-to-male sex in the past 6 months. Baseline and follow-up visits were done at a dedicated study clinic in central Bangkok. Men were tested for HIV infection at every study visit and for sexually transmitted infections at baseline. Baseline demographics and HIV risk behaviour information were collected at every visit by audio computer-assisted self-interview. We used a descriptive model using bivariate odds ratios to elucidate the order of risk factors in the causal pathway to HIV incidence and methamphetamine use. We used Cox proportional hazard regression analysis to evaluate covariates for incident methamphetamine use and HIV infection. FINDINGS: From April 6, 2006, to Dec 31, 2010, 1977 men were screened and 1764 were found eligible. 1744 men were enrolled, of whom 1372 tested negative for HIV and were followed up until March 20, 2012. Per 100 person-years of follow-up, incidence of methamphetamine use was 3.8 (128 events in 3371 person-years) and incidence of HIV infection was 6.0 (212 events in 3554 person-years). In our descriptive model, methamphetamine use, anal sex, and various other behaviours cluster together but their effect on HIV incidence was mediated by the occurrence of ulcerative sexually transmitted infections. Dual risk factors for both incident methamphetamine use and HIV infection were younger age and finding casual sex partners on the internet. Having ever received money for sex was predictive for incident methamphetamine use; living alone or with a housemate, recent anal sex, and ulcerative sexually transmitted infections at baseline were predictive for incident HIV infection. INTERPRETATION: In MSM in Bangkok, casual sex partner recruitment on the internet, methamphetamine use, and sexually transmitted infections have important roles in sustaining the HIV epidemic. Virtual HIV prevention education, drug use harm reduction, and biomedical HIV prevention methods, such as pre-exposure prophylaxis, could help to reduce or revert the HIV epidemic among MSM in Bangkok. FUNDING: US Centers for Disease Control and Prevention. |
Young men who have sex with men at high risk for HIV, Bangkok MSM Cohort Study, Thailand 2006-2014
Thienkrua W , van Griensven F , Mock PA , Dunne EF , Raengsakulrach B , Wimonsate W , Howteerakul N , Ungsedhapand C , Chiwarakorn A , Holtz TH . AIDS Behav 2017 22 (7) 2137-2146 High HIV incidence has been reported in young men who have sex with men (YMSM) in North America and Western Europe, but there are limited data from Southeast Asia suggesting MSM may be the driver of the HIV epidemic in this region. We described HIV incidence and risk factors among 494 YMSM enrolled in a cohort study in Bangkok, Thailand. The HIV incidence was 7.4 per 100 person-years. In multivariable analysis, reporting use of an erectile dysfunction drug in combination with club drugs, having receptive or both insertive and receptive anal intercourse with men, having hepatitis A infection, having rectal Chlamydia trachomatis, having hepatitis B infection prior to HIV seroconversion, and reporting not always using condoms with male steady partners were significantly associated with HIV incidence in YMSM. Reduction in new HIV infections in YMSM are critical to reach targets set by Thailand and the region. |
Subtypes and risk behaviors among incident HIV cases in the Bangkok Men Who Have Sex with Men Cohort Study, Thailand, 2006-2015.
Lam CR , Holtz TH , Leelawiwat W , Mock P , Chonwattana W , Wimonsate W , Varangrat A , Thienkrua W , Rose C , Chitwarakorn A , Curlin ME . AIDS Res Hum Retroviruses 2016 33 (10) 1004-1012 INTRODUCTION: HIV-1 incidence and prevalence remain high among men who have sex with men (MSM), and transgender women (TGW), in Thailand. To examine the link between epidemiologic factors and HIV-1 subtype transmission among Thai MSM, we compared covariates of infection with HIV CRF01-AE and other HIV strains among participants in the Bangkok MSM Cohort Study (BMCS). MATERIALS AND METHODS: The BMCS was an observational cohort study of Thai MSM and TGW with up to 60 months of follow-up at 4-monthly intervals. Participants underwent HIV/STI testing, and provided behavioral data at each visit. Infecting viral strain was characterized by gene sequencing and/or multi-region hybridization assay. We correlated behavioral/clinical variables with infecting strain using Cox proportional hazards. RESULTS: Among a total of 1372 HIV seronegative enrolled participants with 4192 person-years of follow-up, we identified 215 seroconverters between April 2006 and December 2014, with 177 infected with CRF01_AE and 38 with non-CRF01_AE subtype. Age 18-21 years (AHR 2.2, 95% CI: 1.4-3.5), age 22-29 (1.6, 1.1-2.3), living alone (AHR 1.5, 1.1-2.1), drug use (AHR 2.2, 1.4-3.5), intermittent condom use (1.7, 1.3-2.3), any receptive anal intercourse (AHR 1.7, 1.2-2.4), group sex (1.5, 1.1-2.2), anti-HSV-1 (1.5, 1.1-2.1) and T. pallidum antibody positivity (2.5, 1.4-4.4) were associated with CRF01_AE infection. Age 18-21 years (5.1, 1.6-16.5), age 22-29 (3.6, 1.3-10.4), drug use (3.1, 1.3-7.5), group sex (2.4, 1.1-5.0), and hepatitis B virus surface antigen (3.6, 1.3-10.2) were associated with non-CRF01_AE infection. DISCUSSION: We observed several significant biological and behavioral correlates of infection with CRF01_AE and other HIV strains among Thai MSM. Divergence in correlates by strain may indicate differences HIV transmission epidemiology between CRF01_AE and other strains. These differences could reflect founder effects, transmission within networks distinguished by specific risk factors, and possibly biological differences between HIV strains. |
Incidence of and temporal relationships between HIV, herpes simplex II virus, and syphilis among men who have sex with men in Bangkok, Thailand: an observational cohort
Thienkrua W , Todd CS , Chonwattana W , Wimonsate W , Chaikummao S , Varangrat A , Chitwarakorn A , van Griensven F , Holtz TH . BMC Infect Dis 2016 16 340 BACKGROUND: High HIV incidence has been detected among men who have sex with men (MSM) in Thailand, but the relationship and timing of HIV, herpes simplex virus 2 (HSV-2), and syphilis is unknown. This analysis measures incidence, temporal relationships, and risk factors for HIV, HSV-2, and syphilis among at-risk MSM in the Bangkok MSM Cohort Study. METHODS: Between April 2006 and December 2010, 960 men negative for HIV, HSV-2, and syphilis at entry enrolled and contributed 12-60 months of follow-up data. Behavioral questionnaires were administered at each visit; testing for HIV antibody was performed at each visit, while testing for syphilis and HSV-2 were performed at 12 month intervals. We calculated HIV, HSV-2, and syphilis incidence, assessed risk factors with complementary log-log regression, and among co-infected men, measured temporal relationships between infections with Kaplan-Meier survival analysis and paired t-test. RESULTS: The total number of infections and incidence density for HIV, HSV-2, and syphilis were 159 infections and 4.7 cases/100 PY (95 % Confidence Interval (CI): 4.0-5.4), 128 infections and 4.5/100 PY (95 % CI: 3.9-5.5), and 65 infections and 1.9/100 PY (95 % CI: 1.5-2.5), respectively. Among men acquiring >1 infection during the cohort period, mean time to HIV and HSV-2 infection was similar (2.5 vs. 2.9 years; p = 0.24), while syphilis occurred significantly later following HIV (4.0 vs. 2.8 years, p < 0.01) or HSV-2 (3.8 vs. 2.8 years, p = 0.04) infection. The strongest independent predictor of any single infection in adjusted analysis was acquisition of another infection; risk of syphilis (Adjusted Hazards Ratio (AHR) = 3.49, 95 % CI: 1.89-6.42) or HIV (AHR = 2.26, 95 % CI: 1.47-3.48) acquisition during the cohort was significantly higher among men with incident HSV-2 infection. No single independent behavioral factor was common to HIV, HSV-2, and syphilis acquisition. CONCLUSION: HIV and HSV-2 incidence was high among this Thai MSM cohort. However, acquisition of HIV and co-infection with either HSV-2 or syphilis was low during the time frame men were in the cohort. Evaluation of behavioral risk factors for these infections suggests different risks and possible different networks. |
Lubricant use among men who have sex with men reporting anal intercourse in Bangkok, Thailand: impact of HIV status and implications for prevention
Thienkrua W , Todd CS , Chaikummao S , Sukwicha W , Yafant S , Tippanont N , Varangrat A , Khlaimanee P , Sirivongrangson P , Holtz TH . J Homosex 2015 63 (4) 507-21 This analysis measures prevalence and correlates of consistent lubricant use among a cohort of Thai men who have sex with men (MSM). Lubricant use was queried at the 12 month follow-up visit. Consistent lubricant use was evaluated with logistic regression. Consistent lubricant use was reported by 77.0% of men and associated with consistent condom use with casual partners, while binge drinking, payment for sex, and inconsistent condom use with casual, and steady partners, were negatively associated. Though consistent lubricant use is common among this Thai MSM cohort, further promotion is needed with MSM engaging in risky sexual practices. |
Temporal trends in HIV-1 incidence and risk behaviours in men who have sex with men in Bangkok, Thailand, 2006-13: an observational study
van Griensven F , Holtz TH , Thienkrua W , Chonwattana W , Wimonsate W , Chaikummao S , Varangrat A , Chemnasiri T , Sukwicha W , Curlin ME , Samandari T , Chitwarakorn A , Mock PA . Lancet HIV 2015 2 (2) 64-70 BACKGROUND: HIV-1 incidence in men who have sex with men (MSM) is often difficult to estimate. We therefore assessed temporal trends in HIV-1 incidence and behavioural risk factors in MSM in Bangkok, Thailand, from 2006 to 2013. METHODS: In this observational study, we used data for clients attending the Silom Community Clinic for voluntary counselling and testing (VCT) services and from the Bangkok MSM Cohort Study (BMCS) to investigate trends in HIV incidence per 100 person-years per quarter in both cohorts. During VCT, basic demographic data were gathered at registration. However, no behavioural risk data were gathered. In the BMCS, we gathered demographic and behavioural data at baseline and at regular study visits using audio computer-assisted self-interviewing. Questions were included about potential risk factors such as drug use, sexual practices, and how often condoms were used. We also analysed behavioural risk factors in the BMCS cohort, using a restricted cubic spline function for time. FINDINGS: From 2006 to 2013, 8176 MSM came for VCT; 1999 (24%) clients were initially seronegative and returned for another test. 235 (12%) individuals seroconverted. The overall HIV-1 incidence was 55 per 100 person-years (95% CI 48-63), with an increasing trend (adjusted p=002). In the BMCS, 1372 people were seronegative at baseline; 1259 (92%) had more than one follow-up test and 238 (17%) seroconverted. The overall HIV-1 incidence was 53 per 100 person-years (95% CI 47-61), with an increase and then a decline (inverted U-shaped curve, p=00001). Individuals aged 21 years and younger were at significantly higher risk of HIV infection than were those aged 30 years and older in the in the VCT (rate ratio 229, 95% CI 188-278, p<00001) and BMCS cohorts (199, 150-265, p<00001). Overall, drug use (p=003), drug use to enhance sex (p=00006), use of drugs for erectile dysfunction (p<00001), and 100% condom use (p<00001) increased over time, whereas the proportion of individuals reporting receptive anal intercourse decreased (p=0004). INTERPRETATION: With a sustained high HIV-1 incidence and increasing drug use in MSM in Bangkok, we urgently need innovative and acceptable HIV prevention interventions, especially for young MSM. FUNDING: US Centers for Disease Control and Prevention. |
Prevalence and correlates of willingness to participate in a rectal microbicide trial among men who have sex with men in Bangkok
Thienkrua W , Todd CS , Chaikummao S , Sukwicha W , Yafant S , Tippanont N , Varangrat A , Khlaimanee P , Holtz TH . AIDS Care 2014 26 (11) 1-11 Rectal microbicides (RMs) hold promise as a HIV prevention method to reduce transmission among men who have sex with men (MSM). To assess RM trial feasibility in Bangkok, we measured prevalence and correlates of willingness to participate among Thai MSM observational cohort participants. Between April 2006 and December 2010, 1744 MSM enrolled in the Bangkok MSM Cohort Study; at 12 months, RM trial participation willingness was measured. We evaluated correlates of RM trial participation willingness using logistic regression analysis. Participants completing the 12-month visit (81.4%, n = 1419) had a mean age of 27.3 years (SD = 6.1), and 65.5% and 86.1% reported having a steady partner or anal intercourse (AI) in the past four months, respectively. Most (79.1%, n = 1123) participants reported willingness to participate in an RM trial, which, in multivariable analysis, was independently associated with insertive only (adjusted odds ratio [AOR] = 3.25, 95% CI: 1.82-5.81) or receptive/versatile role AI (AOR = 3.07, 95% CI: 1.88-5.01), and being paid for sex (AOR = 12.15, 95% CI: 1.67-88.21) in the past four months, and believing that people with AIDS look sick (AOR = 1.92, 95% CI: 1.23-2.98). Of hypothetical RM trial features to increase enrollment likelihood, the most (91.1%) compelling was that the study be approved by the Thai ethics committee, followed by the study site offering evening hours (88.9%). Reasons not to participate were not wanting a rectal examination (29.5%) or fluid collected from the penis or anus (24.6%) and not wanting the placebo (23.0%). RM trial participation willingness was high, particularly for those with greater HIV acquisition risk, within this Thai MSM cohort, suggesting feasibility of an RM trial. Addressing potential barriers to trial entry may be useful in educational materials to optimize recruitment. |
Evidence of an explosive epidemic of HIV infection in a cohort of men who have sex with men in Bangkok, Thailand
van Griensven F , Thienkrua W , McNicholl J , Wimonsate W , Chaikummao S , Chonwattana W , Varangrat A , Sirivongrangson P , Mock PA , Akarasewi P , Tappero JW . AIDS 2012 27 (5) 825-32 OBJECTIVE: To assess HIV-prevalence, incidence and risk factors in a cohort of men who have sex with men (MSM) in Bangkok. DESIGN: Cohort study with 4-monthly follow-up visits conducted between April 2006 and December 2011 at a dedicated study clinic in a central Bangkok hospital. Participants were 1744 homosexually active Thai men, ≥18 years old and residents of Bangkok. METHODS: Men were tested for HIV-infection at every study visit and for sexually transmitted infections at baseline. Demographic and behavioural data were collected by audio-computer-assisted self-interview. Logistic regression analysis was used to evaluate risk factors for HIV-prevalence and Cox proportional hazard analysis to evaluate risk factors for HIV-incidence. RESULTS: Baseline HIV-prevalence was 21.3% (n = 372) and 60 months cumulative HIV-free survival was 76.1% (n = 222). Overall HIV-incidence density was 5.9 per 100 person-years (PY). Multivariate risk factors for HIV-prevalence were older age, secondary/vocational education (vs. university or higher), employed or unemployed (vs. studying), nitrate inhalation, drug use for sexual pleasure, receptive anal intercourse, history of sexual coercion, no prior HIV-testing, and anti-HSV-1 and 2 and T. pallidum (TP) positivity at baseline. Multivariate risk factors for HIV-incidence were younger age, living alone or with roommate (vs. with a partner or family), drug use for sexual pleasure, inconsistent condom use, receptive anal intercourse, group sex, and anti-HSV-1 and 2 and TP positivity at baseline. Having no anal intercourse partners was inversely associated with HIV-incidence. CONCLUSIONS: The high HIV prevalence and incidence in this cohort of Bangkok MSM documents an explosive epidemic. Additional preventive interventions for MSM are urgently needed. |
Prevalence of Treponema pallidum seropositivity and herpes simplex virus type 2 infection in a cohort of men who have sex with men, Bangkok, Thailand, 2006-2010
Holtz TH , Thienkrua W , McNicholl JM , Wimonsate W , Chaikummao S , Chonwattana W , Wasinrapee P , Varangrat A , Mock PA , Sirivongrangson P , van Griensven F . Int J STD AIDS 2012 23 (6) 424-8 We report prevalence of Treponema pallidum (TP) seropositivity and herpes simplex virus type 2 (HSV-2) infection and risk factors associated with their prevalence in a cohort of men who have sex with men (MSM) in Bangkok, Thailand. Between April 2006 and March 2010 we enrolled Thai MSM into a cohort study based at the Silom Community Clinic, with baseline behavioural data and laboratory testing for sexually transmitted infections (STIs). Logistic regression was used to analyse risk factors associated with the prevalence of TP seropositivity and HSV-2 infection. From a total of 1544 enrolled men (mean age 26 years) TP, HSV-2 and HIV seropositive rates were 4.4%, 20.7% and 21.6%, respectively. After multivariable analysis, participating in group sex, reporting paying for sex, reporting sex with a casual partner in a park and being HSV-2 seropositive were associated with TP prevalence. Age ≥30 years, having less than a high school education, past use of recreational drugs, meeting casual sexual partners at a public venue (sauna) and TP seropositivity were associated with HSV-2 infection. The significant baseline prevalence of TP seropositivity and HSV-2 infection in this cohort demonstrates the need for screening and treatment of these STIs and targeted prevention interventions in Thai MSM in Bangkok. |
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