Background
Clinical data from acute HIV infection (AHI) can provide valuable perspectives on factors associated with ongoing HIV transmission. This analysis examines participant characteristics in the RV254 AHI cohort in Bangkok, Thailand.
Methods
From 2009 to 2023, 539,616 blood samples from HIV test seekers were screened for AHI using a combined immunoassay and nucleic acid test approach. Of the 955 AHI events (0.18%) identified, 726 individuals (76%) were enrolled. They were grouped into three 5-year intervals based on year of enrollment: Group 1 (2009–13), Group 2 (2014–18), and Group 3 (2019–23). Demographic, clinical, mood, and behavioral measures were compared using Chi-square test and non-parametric tests accordingly, with Group 1 as the reference. A subgroup analysis was conducted on 234 Groups 2 and 3 participants who completed a standardized questionnaire on risk behaviors introduced in Sep 2017.
Results
Of the 726 RV254 participants, 708 (98%) were male, 674 (93%) were men who have sex with men (MSM), with a median age of 26 (interquartile range (IQR) 23,31) years, and 420 (58%) had a bachelor’s degree or higher. Age and education level at AHI did not differ between the 3 groups, with consistent predominance of male participants (>90%).
Table 1 compares mood and behavioural measures and co-infections across the groups. While depressive scores measured by the Patient Health Questionnaire (PHQ-9) did not statistically differ between groups, Groups 2 and 3 exhibited lower psychological stress scores on the Distress Thermometer than Group 1 (p<0.01). They also showed higher rates of past and recent syphilis (p<0.01). Group 3 also had higher frequencies of hepatitis C infection (p=0.021) and any pre-exposure prophylaxis (PrEP) use (p<0.001), as PrEP was introduced at the Thai Red Cross in 2015 and in community-led services in 2016.
In the risky behaviour subgroup analysis, over a fifth in Groups 2 and 3 reported methamphetamine (meth) use and group sex prior to AHI. Compared to non-users, meth users had higher frequencies of group sex (51% vs. 17%, p<0.001), past syphilis (38% vs. 23%, p=0.035) and any PrEP usage (17% vs. 6%, p=0.022).
Conclusions
In the last 15 years, young, highly educated MSM predominated new AHI cases detected in Bangkok, Thailand. There was increasing detection of concurrent syphilis and hepatitis C, particularly among meth users, half of whom reported group sex, highlighting the need for integrated service for substance use, HIV and sexually transmitted infections.
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