Browsing by Author "J. Ananworanich"

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    Correlation of selenium and zinc levels to antiretroviral treatment outcomes in Thai HIV-infected children without severe HIV symptoms
    (2012-08-01) T. Bunupuradah; S. Ubolyam; R. Hansudewechakul; P. Kosalaraksa; C. Ngampiyaskul; S. Kanjanavanit; J. Wongsawat; W. Luesomboon; S. Pinyakorn; S. Kerr; J. Ananworanich; S. Chomtho; J. Van Der Lugt; N. Luplertlop; K. Ruxrungtham; T. Puthanakit; The HIV Netherlands Australia Thailand Research Collaboration; Chiangrai Prachanukroh Hospital; Khon Kaen University; Prapokklao Hospital; Nakornping Hospital; Bamrasnaradura Infectious Disease Institute; Queen Savang Vadhana Memorial Hospital; University of New South Wales (UNSW) Australia; Chulalongkorn University; SEARCH; Mahidol University
    Background/Objectives:Deficiencies in antioxidants contribute to immune dysregulation and viral replication. To evaluate the correlation of selenium (Se) and zinc (Zn) levels on the treatment outcomes in HIV-infected children.Subjects/Methods:HIV-infected Thai children 1-12 years old, CD4 15-24%, without severe HIV symptoms were included. Se and Zn levels were measured by graphite furnace atomic absorption spectrometry at baseline and 48 weeks. Deficiency cutoffs were Se 0.1 mol/l and Zn 9.9 mol/l. Serum ferritin and C-reactive protein (CRP) were measured every 24 weeks. No micronutrient supplement was prescribed.Results:In all, 141 children (38.3% male) with a median (interquartile range (IQR)) age of 7.3 (4.2-9.0) years were enrolled. Median baseline CD4% was 20%, HIV-RNA was 4.6 log 10 copies/ml. At baseline, median (IQR) Se and Zn levels were 0.9 (0.7-1.0) mol/l and 5.9 (4.8-6.9) mol/l, respectively. None had Se deficiency while all had Zn deficiency. Over 48 weeks, 97 initiated antiretroviral therapy (ART) and 81% achieved HIV-RNA 50 copies/ml with 11% median CD4 gain. The mean change of Se was 0.06 mol/l (P0.003) and Zn was 0.42 mol/l (P0.003), respectively. By multivariate analysis in children who received ART, predictors for greater increase of CD4% from baseline were lower baseline CD4% (P0.01) and higher baseline Zn level (P0.02). The predictors for greater decrease of HIV-RNA from baseline were higher baseline HIV-RNA and higher ferritin (both P0.01). No association of CRP with the changes from baseline of CD4% or HIV-RNA was found.Conclusion:In HIV-infected Thai children without severe immune deficiency who commenced ART, no correlation between Se and ART treatment outcomes was found. Higher pre-ART Zn levels were associated with significant increases in CD4% at 48 weeks. © 2012 Macmillan Publishers Limited.
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    Ferritin levels during structured treatment interruption of highly active antiretroviral therapy
    (2007-09-01) José Boom; E. Kösters; C. Duncombe; S. Kerr; B. Hirschel; K. Ruxrungtham; Q. De Mast; P. Kosalaraksa; S. Ulbolyam; T. Jupimai; J. Ananworanich; Praphan Phanuphak; David A. Copper; Apicha Mahanontharit; Wisit Prasithsirikul; Ploenchan Chetchotisakda; Sasisopin Kiertiburanakul; Warangkana Munsakul; Phitsanu Raksakulkarn; Somboon Tansuphasawadikul; Sukontha Saenawat; Saijai Wicharuk; Siriporn Nonenoy; Natnipa Wannachai; Theshinee Chuenyam; Vrije Universiteit Amsterdam; Radboud University Nijmegen Medical Centre; The HIV Netherlands Australia Thailand Research Collaboration; Kirby Institute; Hopitaux universitaires de Geneve; Chulalongkorn University; Khon Kaen University; Southeast Asia Research Collaboration with Hawaii (SEARCH); Bamrasnaradura Infectious Disease Institute; Mahidol University; Vajira Hospital; Sanpatong Hospital; Buddhachinnaraj Hospital
    Objective: The aim of the study was to investigate the influence of highly active antiretroviral therapy (HAART) on iron status and, conversely, the influence of iron status on the response to HAART. Methods: Ferritin levels were retrospectively determined in stored plasma from 138 HAART-naïve, moderately immunosuppressed HIV-infected Thai patients participating in a structured treatment interruption trial. Ferritin levels were determined at three predefined time-points: (1) HAART initiation; (2) HAART discontinuation; and (3) HAART resumption. Results: At baseline, 31% and 16% of the HIV-infected patients included in the study had high (>200 ng/mL) and low (<30 ng/mL) ferritin levels, respectively. Ninety-five per cent of patients with low ferritin levels were female. Ferritin decreased significantly during the interruption phase of HAART (-8.8ng/mL; P=0.0005) but remained elevated in 62% of the patients with high baseline levels. A low baseline ferritin level was associated with a shorter time (P= 0.041) to reach the CD4 cell target for HAART interruption (350cells/μL), compared with a normal or high baseline ferritin level. Moreover, in a multivariate model, the relative risk (RR) of arriving at this CD4 cell target was significantly higher [RR 1.81; 95% confidence interval (CI) 1.05-3.14] in patients with low baseline ferritin. It is unlikely that inflammation affected ferritin in our patients, as mean levels of C-reactive protein were not elevated in patients with either high or low ferritin levels. Conclusions: Both high and low ferritin levels were highly prevalent in moderately immunosuppressed HIV-positive Thai patients. Structured treatment interruption of HAART resulted in a significant decrease in overall ferritin levels. Furthermore, subjects with low baseline ferritin levels had a faster and greater CD4 response to HAART, suggesting a potential beneficial effect of iron deficiency on immunological recovery after initiation of HAART. © 2007 British HIV Association.
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    HIV-1 drug resistance mutations in children after failure of first-line nonnucleoside reverse transcriptase inhibitor-based antiretroviral therapy
    (2010-10-01) T. Puthanakit; G. Jourdain; S. Hongsiriwon; P. Suntarattiwong; K. Chokephaibulkit; V. Sirisanthana; P. Kosalaraksa; W. Petdachai; R. Hansudewechakul; U. Siangphoe; T. Suwanlerk; J. Ananworanich; The HIV Netherlands Australia Thailand Research Collaboration; Chulalongkorn University; Chiang Mai University; Regional Hospital; Queen Sirikit National Institute of Child Health; Mahidol University; Khon Kaen University; Petchburi Hospital; Chiang Rai Regional Hospital; South East Asia Research Collaboration with Hawaii
    Objectives: The aim of the study was to assess the prevalence, predictors and patterns of genotypic resistance mutations in children after failure of World Health Organization-recommended initial nonnucleoside reverse transcriptase inhibitor (NNRTI)-based treatment regimens. Methods: We carried out a multicentre retrospective study of genotyping tests performed for all HIV-infected children at eight paediatric centres in Thailand who experienced failure of NNRTI therapy at a time when virological monitoring was not routinely available. Results: One hundred and twenty children were included in the study. Their median age (interquartile range) was 9.1 (6.8-11.0) years, the median duration of their NNRTI regimens was 23.7 (15.7-32.6) months, their median CD4 percentage was 12% (4-20%), and their median plasma HIV RNA at the time of genotype testing was 4.8 (4.3-5.2) log10 HIV-1 RNA copies/mL. The nucleoside reverse transcriptase inhibitor (NRTI) resistance mutations found were as follows: 85% of the children had M184V/I, 23% had at least four thymidine analogue mutations, 12% had the Q151M complex, 5% had K65R, and 1% had the 69 insertion. Ninety-eight per cent of the children had at least one NNRTI resistance mutation, and 48% had etravirine mutation-weighted scores ≥4. CD4 percentage <15% prior to switching regimens [odds ratio (OR) 5.49; 95% confidence interval (CI) 2.02-14.93] and plasma HIV RNA>5 log10 copies/mL (OR 2.46; 95% CI 1.04-5.82) were independent predictors of at least four thymidine analogue mutations, the Q151M complex or the 69 insertion. Conclusions: In settings without routine viral load monitoring, second-line antiretroviral therapy regimens should be designed assuming that clinical or immunological failure is associated with high rates of multi-NRTI resistance and NNRTI resistance, including resistance to etravirine. © 2010 British HIV Association.
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    Predictors of clinical progression in HIV-1-infected adults initiating combination antiretroviral therapy with advanced disease in the Asia-Pacific region: Results from the TREAT Asia HIV Observational Database
    (2013-07-01) H. Byakwaga; K. Petoumenos; J. Ananworanich; F. Zhang; M. A. Boyd; T. Sirisanthana; P. C.K. Li; C. Lee; C. V. Mean; V. Saphonn; S. F.S. Omar; S. Pujari; P. Phanuphak; P. L. Lim; N. Kumarasamy; Y. M.A. Chen; T. P. Merati; S. Sungkanuparph; R. Ditangco; S. Oka; G. Tau; J. Zhou; M. G. Law; S. Emery; University of New South Wales (UNSW) Australia; The HIV Netherlands Australia Thailand Research Collaboration; Beijing Ditan Hospital; Research Institute for Health Sciences; Queen Elizabeth Hospital Hong Kong; Hospital Sungai Buloh; National Center for HIV/AIDS; University of Malaya; Institute of Infectious Diseases; Tan Tock Seng Hospital; YR Gaitonde Centre for AIDS Research and Education; National Yang-Ming University Taiwan; Universitas Udayana; Mahidol University; Gokila; National Center for Global Health and Medicine; Port Moresby General Hospital
    The majority of HIV-infected patients in developing countries commences combination antiretroviral therapy (cART) with advanced disease. We examined predictors of disease progression in patients initiating cART with CD4 count ≤200 cells/mm3 in the TREAT Asia HIV Observational Database. The main outcome measure was progression to either an AIDS-defining illness or death occurring 6 months after initiation of cART. We used survival analysis methods. A total of 1255 patients contributed 2696 person years of follow-up; 73 were diagnosed with AIDS and 9 died. The rate of progression to the combined end point was 3.0 per 100 person years. The factors significantly associated with a higher risk of disease progression were Indian ethnicity, infection through intravenous drug use, lower CD4 count, and hemoglobin ≤130 g/dL at 6 months. In conclusion, measurements of CD4 count and hemoglobin at month 6 may be useful for early identification of disease progression in resource-limited settings. © The Author(s) 2012.
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    A survey of paediatric HIV programmatic and clinical management practices in Asia and sub-Saharan Africa - The International epidemiologic Databases to Evaluate AIDS (IeDEA)
    (2013-01-15) V. Saphonn; U. Vibol; N. Kumarasamy; N. Kurniati; S. M. Fong; N. K. Nik Yusoff; K. A. Razali; R. Nallusamy; V. Sirisanthana; R. Hansudewechakul; P. Lumbiganon; J. Ananworanich; K. Chokephaibulkit; H. K. Truong; C. V. Do; B. V. Huy; A. H. Sohn; M. G. Law; Cleophas Chimbetete; Brian Eley; Daniele Garone; Janet Giddy; Harry Moultrie; Sam Phiri; Hans Prozesky; Karl Technau; Paula Vaz; Robin Wood; François Dabis; Emmanuel Bissagnene; Marcel D. Zannou; Joseph Drabo; Serge Paul Eholie; Kevin Peterson; Lorna Renner; Moussa Maiga; Man Charurat; Haby Signaté Sy; Didier K. Ekouévi; Antoine Jaquet; Valériane Leroy; Charlotte Lewden; Annette H. Sohn; National Centre for HIV/AIDS Dermatology and STDs; National Pediatric Hospital; Gaitonde Centre for AIDS Research and Education; General Hospital; Hospital Likas; Hospital Raja Perempuan Zainab II; Kuala Lumpur Hospital; Penang Hospital; Chiang Mai University; Chiangrai Prachanukroh Hospital; Khon Kaen University; The HIV Netherlands Australia Thailand Research Collaboration; Mahidol University; Children's Hospital 1; Children's Hospital 2; National Hospital of Pediatrics Hanoi; amfAR - The Foundation for AIDS Research; University of New South Wales (UNSW) Australia; Newlands Clinic; Red Cross War Memorial Children's Hospital; Khayelitsha ART Programme and Médecins Sans Frontières; McCord Hospital; University of Witwatersrand; Lighthouse Clinic; Tygerberg Hospital; Paediatric Day Hospital; Desmond Tutu HIV Centre (Gugulethu and Masiphumelele clinics); Inserm; Centre Hospitalier Universitaire de Treichville; Foundation for AIDS Research
    Introduction: There are limited data on paediatric HIV care and treatment programmes in low-resource settings. Methods: A standardized survey was completed by International epidemiologic Databases to Evaluate AIDS paediatric cohort sites in the regions of Asia-Pacific (AP), Central Africa (CA), East Africa (EA), Southern Africa (SA) and West Africa (WA) to understand operational resource availability and paediatric management practices. Data were collected through January 2010 using a secure, web-based software program (REDCap). Results: A total of 64,552 children were under care at 63 clinics (AP, N =10; CA, N =4; EA, N =29; SA, N =10; WA, N =10). Most were in urban settings (N =41, 65%) and received funding from governments (N =51, 81%), PEPFAR (N =34, 54%), and/or the Global Fund (N =15, 24%). The majority were combined adult-paediatric clinics (N =36, 57%). Prevention of mother-to-child transmission was integrated at 35 (56%) sites; 89% (N =56) had access to DNA PCR for infant diagnosis. African (N =40/53) but not Asian sites recommended exclusive breastfeeding up until 4-6 months. Regular laboratory monitoring included CD4 (N =60, 95%), and viral load (N =24, 38%). Although 42 (67%) sites had the ability to conduct acid-fast bacilli (AFB) smears, 23 (37%) sites could conduct AFB cultures and 18 (29%) sites could conduct tuberculosis drug susceptibility testing. Loss to follow-up was defined as >3 months of lost contact for 25 (40%) sites, >6 months for 27 sites (43%) and >12 months for 6 sites (10%). Telephone calls (N =52, 83%) and outreach worker home visits to trace children lost to follow-up (N =45, 71%) were common. Conclusions: In general, there was a high level of patient and laboratory monitoring within this multiregional paediatric cohort consortium that will facilitate detailed observational research studies. Practices will continue to be monitored as the WHO/UNAIDS Treatment 2.0 framework is implemented. © 2013 IeDEA Pediatric Working Group; licensee International AIDS Society.