ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July 18-23 2010, Vienna Austria Recent Trends in estimated HIV-1.

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ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria Recent Trends in estimated HIV-1 Incidence among Royal Thai Army (RTA) conscripts from in Thailand Major Sutchana Tabprasit Armed Forces Research Institute of Medical Sciences (AFRIMS), Royal Thai Army (RTA), Bangkok, Thailand

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria Primary HIV-1 Infection Acute infection Rapid viral replication 80-90% develop an acute syndrome characterized by flu-like symptoms Broad HIV-1 specific immune response

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria Recent HIV-1 Infection (Incidence) Difference of HIV-1 antibody in various aspects - Titer - Proportion - Isotype (avidity)

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria Adults and children estimated to be living with HIV, 2008 UNAIDS Report on the global AIDS epidemic

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria Estimated number of adults and children newly infected with HIV, 2008 UNAIDS Report on the global AIDS epidemic

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria Pre-seroconversion HIV-1 RNA / DNA p24 Antigen Methods for Detection Early HIV Infection (1)

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria Post-seroconversion Less sensitive EIAs IgG-capture BED-EIA Avidity assays Anti-p24 IgG3 Antibodies Methods for Detection Early HIV Infection (2)

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria Advantages of HIV-1 Incidence To monitor the effectiveness of the national prevention and control programs To determine active area of HIV transmission To design the possibility to conduct HIV vaccine trail

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria -To estimate the HIV-1 incidence among the Royal Thai Army (RTA) conscripts Objective

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria Thailand

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria Recruitment of young Thai males occurs in April each year 60,000 Males/year

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria HIV-1 SEROPREVALENCE OF YOUNG MEN ENTERING THE ROYAL THAI ARMY Year HIV-1 Seroprevalence

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria The dot density of seroprevalence among recruits in the Royal Thai Army (RTA), Positive= 1,316 dots Prevalence= 1,316/268,504 (0.5%) 1 dot = 1 prevalent case

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria HIV Seropositive Detection From RNR ELISA I PositiveNIndeterminate WB/ ELISA II and III BED-EIA 1, ,

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria IgG- Capture HIV-EIA

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria Principles of IgG- Capture HIV-EIA 96-well plate is coated with goat anti-human IgG

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria 1. add specimen IgG antibodies from plasma/serum 2. add Biotinylated HIV-1 BED peptide (gp41) 3. add Streptavidin–HRP Conjugate 4. add substrate Principles of IgG- Capture HIV-EIA

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria Read at wavelength 450 nm with reference wavelength nm Spectrophotometer Plate Principles of IgG- Capture HIV-EIA

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria Assay Validation : Run Control R2R2 OD-N = OD/ Median OD of Calibrator

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria The Algorithm of IgG Capture HIV-EIA Confirmed HIV-seropositive specimens Test in single If ODn > 1.2 Long-term Seroconversion If ODn ≤ 1.2 Repeat test in triplicate (Confirmatory) If Median ODn > 0.8 Long-term Seroconversion If Median ODn ≤ 0.8 Recent Seroconversion

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria Results Figure 1: HIV incidences at time of entry into the RTA Percent per year Year

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria Table 1: HIV-1 incidence among the RTA Conscripts From by demographic factors Demographic Factors Number of Conscripts Number of HIV-1 positive (Seroprevalence) Number of BED-CEIA positive Incidence (95% confidence interval) Age 18 – 2026,67687 (0.33)270.19(0.12 – 0.27) 21190, (0.43) (0.17 – 0.22) 22 – 3040, (0.83) (0.25 – 0.40) Education 0 – 668, (0.69) (0.20 – 0.30) 7 – 988, (0.42) (0.12 – 0.19) >9102, (0.38) (0.21 – 0.29) Marital Status Single209,6701,057 (0.50) (0.21 – 0.27) Married47, (0.42) (0.09 – 0.17)

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria Summary  Increasing trend of HIV incidence in the recent years alerts the active program for HIV prevention and control programs in Thailand  HIV incidence was higher in recruited subjects with older age. (22-30 years)  IgG capture BED is a promising predictor to estimate HIV incidence in the future.

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria Acknowledgement Conscripts of the Royal Thai Army Armed Forces Research Institute of Medical Sciences (AFRIMS) Army Institute of Pathology, King Mongkut Medical Center Bureau of Epidemiology, Department of Disease Control of Ministry of Public Health (MOPH) Thailand MOPH - U.S. Centers for Disease Control and Prevention (CDC) Collaboration

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria Thank you so much

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria Early HIV Infection Adapted from Parekh BS, McDougal JS. Indian J Med Res 2005;121(4):

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria Methods for Estimating HIV Incidence

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria 155 days Level Time since infection Difference between BED-CEIA and HIV screening test

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria BED Branch Peptide Antigen

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria Prevalence Formula Number of HIV-1 infection Number of total in the survey 100 P =

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria Adjustment of Incidence Formula R -ɛP (R/2) + N(w/365) - ɛN - ɛP/2) W=155 days R=Total testing recent in the BED-CEIA N=Total testing HIV negative P=Total testing HIV positive ɛ =False recent rate in those with ling term (>2weeks) infection 100I =

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria Plate Plan For Sample

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria Plate Plan For Sample

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria Acceptable ODn Ranges of Controls and Calibrator Acceptable Median OD Ranges of Controls and Calibrator

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria Highly active antiretroviral therapy (HAART)  Combination chemotherapy for HIV infection consisting of reverse transcriptase inhibitors and a viral protease inhibitor.  Produce marked increase in peripheral blood CD4 + T cells and decreases in HIV plasma RNA copy number.  Reduce plasma virus titers to below detectable levels for more than 1 year and slow the progression of HIV disease.

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria

ARMED FORCES RESEARCH INSTITUTE OF MEDICAL SCIENCES XVIII International AIDS Conference, July , Vienna Austria Specificity Adjustment (Hargrove et al)