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Title: Thai national guidelines for antiretroviral therapy in HIV-1 infected adults and adolescents 2010
Authors: Somnuek Sungkanuparph
Wichai Techasathit
Chitlada Utaipiboon
Sanchai Chasombat
Sorakij Bhakeecheep
Manoon Leechawengwongs
Kiat Ruxrungtham
Praphan Phanuphak
Mahidol University
Global AIDS Program
Thailand Ministry of Public Health
National Health Security Office
Thai Transplantation Society
Chulalongkorn University
The HIV Netherlands Australia Thailand Research Collaboration
Keywords: Biochemistry, Genetics and Molecular Biology;Medicine
Issue Date: 1-Aug-2010
Citation: Asian Biomedicine. Vol.4, No.4 (2010), 515-528
Abstract: In Thailand, more than 150,000 patients are currently treated with antiretroviral drugs under the support of the National AIDS Program (NAP). The appointed Adults and Adolescents Committee consisted of 28 members who are experts in HIV research, patient care or health care policy. Relevant published literature, guidelines, and the most recent relevant clinical trials presented internationally were reviewed. Several peer review and clinical studies conducted in Thailand were included in the review process. Special considerations for patients with co-infection of tuberculosis or hepatitis B were incorporated. Appropriate cut-off of CD4+ T-cell counts when to commence ART among Thai patients have been considered. It is now recommended to start ART at CD4+ T-cell count <350 cells/mm3. For treatment-naive patients, the preferred initial therapy is a nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimen containing lamivudine plus zidovudine or tenofovir. Stavudine will be phased out in a two-year plan at the national program level. Viral load and CD4+ T-cell counts should be monitored at least once and twice a year. To achieve long-term treatment success, enhancing adherence together with the proper management of antiretroviral-related toxicity is critical. In summary, the major changes from the Thai 2008 guidelines include commencing ART earlier. ART is recommended regardless of CD4+ T cell count if patients have an indication to treat their HBV co-infection. Preferred first regimen uses AZT or TDF, not d4T as the NRTI-backbone. Furthermore, efavirenz is now considered a preferred NNRTI, along with nevirapine.
ISSN: 19057415
Appears in Collections:Scopus 2006-2010

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