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Human leukocyte antigen (HLA) alleles have been linked to HIV disease progression and attributed to differences in cytotoxic T lymphocyte (CTL) epitope representation. These findings are largely based on treatment-naive individuals of European and African ancestry. We assessed HLA associations with HIV-1 outcomes in 1,318 individuals from Thailand and found HLA-B∗46:01 (B∗46) associated with accelerated disease in three independent cohorts. B∗46 had no detectable effect on HIV-specific T cell responses, but this allele is unusual in containing an HLA-C epitope that binds inhibitory receptors on natural killer (NK) cells. Unbiased transcriptomic screens showed increased NK cell activation in people with HIV, without B∗46, and simultaneous single-cell profiling of surface proteins and transcriptomes revealed a NK cell subset primed for increased responses in the absence of B∗46. These findings support a role for NK cells in HIV pathogenesis, revealed by the unique properties of the B∗46 allele common only in Asia.

We report positivity rates of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infection at each anatomic site among asymptomatic men who have sex with men (MSM). We calculated the number needed to screen (NNS) to detect CT and NG infection at each anatomic site. From 2006 to 2010, we enrolled Thai MSM, age ≥ 18 years into the Bangkok MSM Cohort Study. Participants underwent physical examination and had rectal, urethral, and pharyngeal screening for CT and NG infection using nucleic acid amplification tests (NAATs). Of 1744 enrollees, 1696 (97.2%) had no symptoms of CT and NG infection. The positivity rates of CT and NG infection at any site were 14.3% (rectum, urethra, pharynx) and 6.4% (rectum, urethra), respectively. The NNS to detect rectal CT and rectal NG infections was 10 and 16, respectively (p

Since 2010, the Thailand Ministry of Public Health has recommended that men who have sex with men (MSM) have an HIV test at least two times a year. We calculated the proportion of, and factors associated with, testing adherence among the HIV-uninfected MSM clients attending Silom Community Clinic @TropMed. We defined testing adherence as repeating at least one HIV test within six months of an initial HIV-negative test, and used log-binomial regression to test for associated factors. We included 1927 clients during 2011–2014; 362 (19%) were adherent with an increased trend ( p

Theme C (Preventing HIV and related infections: Epidemiology and Prevention in Australia and the Region). Background Repeat Neisseria gonorrhoeae (NG) infections indicate ongoing HIV and STI risk among men who have sex with men (MSM). We examined repeat NG among MSM enrolled in the Bangkok MSM Cohort Study (BMCS). Methods Sexually-active Thai MSM aged ≥18 years from Bangkok were enrolled in the BMCS during 2006–2008 (Period1) and 2009–2010 (Period2) and were followed every 4 months for 3–5 years. At baseline, participants were screened for rectal and urethral NG and Chlamydia trachomatis (CT) infections using a nucleic acid amplification test (NAAT). Symptomatic participants at follow-up (i.e. men with urethral or anal discharge, urethral pain and rectal pain) had urethral or rectal specimens tested for NG by NAAT, and were treated if positive. We evaluated baseline factors associated with number of symptomatic NG infections using Poisson regression with robust standard error. Results Among 1,595 participants who had specimens at enrollment (median age 26 years, Interquartile range (IQR): 22–30 years), prevalence of rectal and urethral NG was 6.1% and 1.8%, respectively. Of the 1,439 participants with at least one follow-up visit, 119 had NG infection at any follow-up visit. Forty-four (37.0%) had repeat NG (range 2–7), and 21/44 (47.7%) had only 2 infections. The median time between the first 2 infections was 294 days (IQR: 169–461 days). Factors significantly associated with number of symptomatic NG infections were enrollment in Period1 (Adjusted Incidence Rate Ratio (AIRR), 2.5, 95% Confidence Interval (CI), 1.5–4.3), history of HIV testing without awareness of test result (AIRR 2.8, 95% CI 1.2–6.7), history of previous STI (AIRR 2.9, 95% CI 1.8–4.4), and prevalent CT infection (AIRR 2.2, 95% CI 1.4–3.6). Conclusion Repeat NG infections among BMCS participants were found and associated with other STIs. After NG diagnosis and treatment, follow-up evaluation in 3 months for repeat NG infection is warranted.

Background In several urban areas globally, reports describe increasing sexually transmitted infection (STI) prevalence attributed to group sex characterised by Internet-based networks and drug use among men who have sex with men (MSM). In Thailand, “high parties” (HPs) (group sex with concomitant drug use) have emerged as possible drivers of STI epidemics among MSM; this analysis aims to describe associated factors. Methods In the ongoing Bangkok MSM Cohort Study, participants are Thai MSM aged > 18 years followed every 4 months for 60 months for HIV testing and behavioural questionnaire completion. Questions regarding HPs were introduced in April 2010, with analysis limited to men contributing HP data through January 2013. We assessed HP descriptors among attendees using proportions and factors associated with HP attendance using generalised estimating equations. Results Of 1340 men, prior HP attendance was reported by 207 (15.4%), of whom 161 joined in the previous 4 months. Of recent attendees, 60.3% reported consistent condom use, while 11.7% reported never using condoms at HPs. In a multivariable model, HP attendance in the previous 4 months was independently associated with sex while intoxicated (Adjusted Odds Ratio (AOR) 7.60, 95% CI: 4.43–13.0), methamphetamine (AOR 7.10, 95% CI: 4.15–12.1), gamma hydroxybutyrate (AOR 3.08, 95% CI: 1.15–8.20) and Viagra (AOR 2.35, 95% CI: 1.60–3.43) use, finding partners in Internet chat rooms (AOR 1.56, 95% CI: 1.12–2.27), and sex with casual partners at school/work (AOR 2.61, 95% CI: 1.05–6.53), in a partner’s home (AOR 1.66, 95% CI: 1.20–2.29), or in a hotel (AOR 1.56, 95% CI: 1.12–2.17) in the previous four months. Conclusions HP attendance is strongly associated with multi-drug use and sex while intoxicated, increasing STI transmission risk. Internet-based education regarding drug use and condoms and non-coitally dependent prevention technologies are urgently needed among MSM in Bangkok.