Browsing by Author "Thanomsak Anekthananon"

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    Association of nevirapine levels with rash or hepatotoxicity among HIV-infected Thai women
    (2012-12-01) Winai Ratanasuwan; Tavatchai Jariyasethpong; Thanomsak Anekthananon; Poj Intalapaporn; Supornchai Kongpatanakul; Piyapat Pongnarin; Punneeporn Wasinrapee; Nartlada Chantharojwong; Boonyos Raengsakulrach; Philip J. Peters; Janet Mcnicholl; Michelle S. Mcconnell; Paul J. Weidle; Mahidol University; Rajavithi Hospital; Centers for Disease Control (CDC), Thailand Field Station; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
    Background: We performed a nested case-control study of Thai women prescribed nevirapine-based antiretroviral therapy (ART) to determine if development of rash or hepatotoxicity during the first 24 weeks of treatment is associated with plasma nevirapine concentrations. Method: From May 2005-January 2007, we enrolled 217 women initiating nevirapine-based ART in Thailand. Cases (n = 54) were women who during the first 24 weeks of treatment with nevirapine developed rash (any grade, n = 42) or hepatotoxicity (≥grade 2, n = 22, [10 had both]). Controls were the next enrolled woman who was confirmed not to meet the case definition during the first 24 weeks. Nevirapine concentrations after the two week lead-in dose of 200 mg once daily were compared between cases and controls by Wilcoxon rank-sum tests. Results: We found no difference in Week 2 pre-dose nevirapine concentrations: cases median = 3,528 ng/mL (n = 24), controls median = 3,150ng/mL (n = 30), p = 0.5. Cases had higher post-dose nevirapine concentrations (median = 6,150 ng/mL, n = 21) than controls (median = 4,746 ng/mL, n = 20, p = 0.02). When limited to cases who developed a rash at Week 2, we found no differences in the pre-dose (median = 3,270 ng/mL, n = 12, p = 0.9) or post-dose nevirapine concentration (median = 5,443 ng/mL, n = 9, p = 0.4) compared with controls. Conclusions: We cannot conclude definitively that nevirapine concentrations at two weeks of therapy are associated with rash or hepatotoxicity. It is unlikely that therapeutic drug monitoring at that time will improve identification of patients at risk for rash or hepatotoxicity. © Ratanasuwan et al.; Licensee Bentham Open.
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    Body shape and metabolic abnormalities in Thai HIV-infected patients
    (2007-11-01) Mayuree Homsanit; Kenrad E. Nelson; Areeuea Sonjai; Thanomsak Anekthananon; Surapol Suwanagool; Joseph Cofrancesco; Mahidol University; Johns Hopkins Bloomberg School of Public Health; The Johns Hopkins School of Medicine; Faculty of Medicine, Siriraj Hospital, Mahidol University
    Fat and metabolic abnormalities and their associated factors in HIV-infected patients in Thailand were examined. Body fat and fasting lipids (total cholesterol, TC; triglyceride, TG; and HDL-cholesterol, HDL-c) were evaluated in 247 HIV-infected Thais. Body fat was evaluated by subjects and blinded observers, and measured using dual-energy X-ray absorptiometry. Descriptive statistics and logistic regression were used for analyses. Antiretroviral (ARV)-treated Thais were significantly older, more likely to be male, and had higher education and income compared to untreated subjects. The prevalence of lipoatrophy was 10.3% in ARV-naive patients, 36.7% in patients receiving non-protease inhibitor (PI)-based ARV, and 78.7% in PI-based ARV-treated patients (p < 0.001). Excess abdominal or neck fat was found in 0.8%, 6.7%, and 24.6% of the naive, non-PI-treated, and PI-treated, respectively (p < 0.001). Hypercholesterolemia (TC ≥ 240 mg/dl) was found in 4.8%, 26.6%, and 42.6%; hypertriglyceridemia (TG ≥ 150 mg/dl) in 8.2%, 48.3%, and 75.4%; and low HDL-c (HDL-c < 40 mg/dl) in 42.9%, 20.0%, and 31.2% of the naive, non-PI treated, and PI-treated, respectively (p < 0.05 for all). Central to peripheral fat ratios were 1.11 ± 0.03, 1.45 ± 0.06, and 1.93 ± 0.08 for the naive, non-PI, and PI-treated, respectively (p < 0.001). Treatment was associated with abnormal fat. The adjusted ORs (95% CI) of lipoatrophy for excess fat were 4.6 (2.0-10.7); 6.3 (0.6-71.1) for ARV-naive vs. non-PI; 5.6 (3.4-9.1); 10.7 (3.4-33.8) for ARV-naive vs. PI, and 5.7 (2.4-13.9); 5.3 (1.2-11.4-13.9) for ARV-naive vs. PI. ARV-associated metabolic abnormalities are common in this non-Western population. Appropriate selection and monitoring of ARV treatment are critical to minimize the risk of long-term complications. © Mary Ann Liebert, Inc. 2007.
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    The burden of HIV-associated neurocognitive disorder (HAND) in the Asia-Pacific region and recommendations for screening
    (2016-08-01) Everall Ian; Chan Lai Gwen; Chow Ting Soo; Corr Melissa; Huang Chun-Kai; Kim Eosu; Kim Hyo-Youl; Khan Asad; Letendre Scott; Li Patrick Chung-Ki; Thanomsak Anekthananon; Treisman Glenn Jordan; Wei Han-Ting; Wong Wing-Wai; University of Melbourne; Tan Tock Seng Hospital; Hospital Pulau Pinang; Royal Prince Alfred Hospital; I-Shou University; Yonsei University College of Medicine; Yonsei University, Wonju College of Medicine; Tawam Hospital; University of California, San Diego; Queen Elizabeth Hospital Hong Kong; Mahidol University; Johns Hopkins University; Veterans General Hospital-Taipei; National Yang-Ming University Taiwan
    © 2015 Elsevier B.V. Background HIV-associated neurocognitive disorder incurs a significant burden on HIV patients in Asia-Pacific countries; however, the incidence is difficult to estimate due to a lack of local epidemiological data. The impact of neurocognitive impairment in HIV patients is often underestimated due to a lack of education and awareness, and there are consequently gaps in the provision of screening and diagnosis to enable earlier intervention to limit neurocognitive impairment. Method This review seeks to redress the imbalance by promoting awareness and education among physicians concerning the neurovirulence of HIV and thereby increase screening efforts to improve diagnosis rates and clinical outcomes for underserved patients in this region. The Asia, Australia, and Middle East (AAME) HAND Advisory Board convened expert regional representatives to review current practice and recommend appropriate measures related to the implementation of standardised screening programmes and treatment recommendations to curb the developing HAND epidemic in the region. In particular, we recommend basic neuropsychological testing protocols that could be efficiently introduced into clinical practice for routine screening. Result We also propose simple guidelines for the management of HAND. We believe that HAND is a significant and under-reported diagnosis in HIV patients that warrants both greater recognition and further clinical investigation of the underlying pathophysiology and the impact of HIV disease progression, with HAND being associated with worse medication adherence and therefore possibly increased risk of ARV treatment failure. Discussion Widespread screening will lead to greater recognition of HAND and earlier intervention, which may lead to improved management strategies in the future.
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    Causes of death in HIV-infected persons who have tuberculosis, Thailand
    (2009-02-01) Kevin P. Cain; Thanomsak Anekthananon; Channawong Burapat; Somsak Akksilp; Wiroj Mankhatitham; Chawin Srinak; Sriprapa Nateniyom; Wanchai Sattayawuthipong; Theerawit Tasaneeyapan; Jay K. Varma; Centers for Disease Control and Prevention; Mahidol University; Thailand Ministry of Public Health; Office of Disease Prevention and Control 7; Bamrasnaradura Infectious Disease Institute; Bangkok Metropolitan Administration; Phuket Provincial Public Health Office
    Up to 50% of persons with HIV and a diagnosis of tuberculosis (TB) in Thailand die during TB treatment. In a prospective observational study, a team of physicians ascribed the cause of death after reviewing verbal autopsies (interviews of family members about events preceding death), laboratory data, and medical records. Of 849 HIV- infected TB patients enrolled, 142 (17%) died. The cause of death was TB for 38 (27%), including 6 with multidrug- resistant TB and 20 with disseminated TB; an HIV-associ- ated condition other than TB for 50 (35%); and a condition unrelated to TB or HIV for 22 (15%). Twenty-three patients (16%) were judged not to have had TB at all. Death from all causes except those unrelated to TB or HIV was less common in persons receiving antiretroviral therapy (ART). In addition to increasing the use of ART, death rates may be reduced through expanded use of modern TB diagnostic techniques.
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    Cryptococcal immune reconstitution inflammatory syndrome after antiretroviral therapy in AIDS patients with cryptococcal meningitis: A prospective multicenter study
    (2009-09-15) Somnuek Sungkanuparph; Scott G. Filler; Ploenchan Chetchotisakd; Peter G. Pappas; Tracy L. Nolen; Weerawat Manosuthi; Thanomsak Anekthananon; Michèle I. Morris; Khuanchai Supparatpinyo; Heather Kopetskie; Amy S. Kendrick; Philip C. Johnson; Jack D. Sobel; Robert A. Larsen; Faculty of Medicine, Ramathibodi Hospital, Mahidol University; Mahidol University; Khon Kaen University; Bamrasnaradura Infectious Diseases Institute; Chiang Mai University; Harbor-UCLA Medical Center; University of Southern California; University of Miami Leonard M. Miller School of Medicine; University of Alabama; University of Texas System; Wayne State University; Federal Systems Division; Faculty of Medicine, Thammasat University
    A prospective multicenter study of cryptococcal immune reconstitution inflammatory syndrome (IRIS) was conducted as a substudy of the Bacteriology and Mycology Study Group 3-01. Of 101 AIDS patients with cryptococcal meningitis who received highly active antiretroviral therapy (HAART), 13 experienced cryptococcal IRIS. No association between the timing of HAART initiation and the diagnosis of IRIS was identified. Increased baseline serum cryptococcal antigen (CrAg) titer was a risk factor for cryptococcal IRIS. © 2009 by the Infectious Diseases Society of America. All rights reserved.
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    Diagnostic accuracy of perfusion CT in differentiating brain abscess from necrotic tumor
    (2009-04-01) Orasa Chawalparit; Chenchira Artkaew; Thanomsak Anekthananon; Nanthasak Tisavipat; Panida Charnchaowanish; Tumtip Sangruchi; Mahidol University; Faculty of Medicine, Siriraj Hospital, Mahidol University
    Objective: To evaluate the diagnostic accuracy of perfusion computed tomography (CTP) in differentiating between brain abscess and necrotic tumor. Material and Method: Prospective study was performed in patients suspected of a space taking lesion in the brain. CTP was done at the suspected levels and post-processing measurement of cerebral blood volume (CBV), cerebral blood flow (CBF), mean transit time (MTT), and permeability surface index (PS) were evaluated at ring enhanced area, central non-enhanced area, edema and contralateral normal brain. Results: Seventeen patients with 21 lesions were studied. Of the 21 lesions, 12 were abscess and nine were tumors. By comparing means, only MTT at the ring enhanced area showed statistically significant difference between brain abscess and tumor (p = 0.009, 95% CI = 1.403 to 4.900). When ratio of CBV, CBF, and MTT of the ring enhanced area and contralateral normal brain were analyzed (CBVr, CBFr, MTTr respectively), there were significant differences of CBVr and CBFr between the two groups (p = 0.003, 95% CI = -4.266 to -1.051 and p = 0.006, 95% CI = -9.934 to -1.969 respectively). With the threshold of CBVr more than or equal to 1.5 and CBFr more than or equal to 1, the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for diagnosis of tumor were 100%, 75%, 75%, 100%, and 85.7% respectively. Conclusion: The CTP was shown to be useful in differentiating brain abscess from tumor. With CBVr less than 1.5, tumor can be excluded.
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    Effect of double dose oseltamivir on clinical and virological outcomes in children and adults admitted to hospital with severe influenza: Double blind randomised controlled trial
    (2013-06-08) Endang Rahayu Sedyaningsih; Moh Suhud Malik; Vivi Setiawaty; Trihono Trihono; Erlina Burhan; Tjandra Yoga Aditama; Prijanti Z. Soepandi; Lia G. Partakusuma; Agung P. Sutiyoso; Ika Priatni; Hadi Jusuf; Emmy Hermiyanti Pranggono; Arto Yuwono Soeroto; Djatnika Setiabudi; Dadang Hudaya Somasetia; Sri Sudarwati; Tini T. Maskoen; Yovita Hartantri; Ida Parwati; Sardikin Giriputro; Dewi Murniati; Sondang Maryutka Sirait; Tony Soetanto; Sri Sulastri; Rismali Agus; Adria Rusli; Sila Wiweka; Steve Wignall; Kevin Baird; Iko Safika; Chariya Sangsajja; Weerawat Manosuthi; Patama Sutha; Chareon Chuchottaworn; Piamlarp Sansayunh; Kittima Bangpattanasiri; Walter R.J. Taylor; Kasia Stepniewska; Caroline Fukuda; Niklas Lindegardh; Nicholas White; Nick Day; Tawee Chotpitayasunondh; Piyarat Suntarattiwong; Umaporn Chantbuddhiwet; Supichaya Netsawang; Kulkanya Chokephaibulkit; Nirun Vanprapar; Wasana Prasitsuebsai; Orasri Wittawatmongkol; Thanomsak Anekthananon; Winai Ratanasuwan; Yong Rongrungruang; Pilaipan Puthavathana; Paul A. Tambyah; Yee Sin Leo; Dale Fisher; Louis Chai; Lawrence Lee; Raymond Lin; Ngo Ngoc Quang Minh; Truong Huu Khanh; Le Phan Kim Thoa; Le Anh Tuan; Tran Thi My Dung; Lam Thi Thuy Ha; Le Minh Qui; Le Quoc Thinh; Nguyen Ngoc Tu Anh; Tran Anh Tuan; Trinh Hong Nhien; Bui Pham Phuong; Phan Tu Qui; Tieu Chau Thy; Bui Xuan Vu; Le Binh Bao Tinh; Dang Thi Thanh; Vo Phuong Khanh; Do Chau Viet; Tran Thi Thuy; Vo Quoc Bao; Le Nguyen Nhat Trung; Ho Thi Kim Thoa; Tran Thi Ngoc Anh; Tran Thi Thu Loan; Tran Quynh Huong; Nguyen Thi Hanh Le; Ho Lu Viet; Ha Manh Tuan; Nguyen Thi Thanh Ha; Nguyen Van Vinh Chau; Nguyen Thanh Truong; Le Thi Thu Thao; Nguyen Thanh Phong; Pham Tran Dieu Hien; Pham Thi Hai Men; Cao Thi Tam; Tran Vinh Diet; Nguyen Van Hao; Badan Penelitian Dan Pengembangan Kesehatan, Kementerian Kesehatan Republik Indonesia; Persahabatan Hospital; Rumah Sakit Hasan Sadikan Bandung; Sulianto Saroso Hospital Jakarta; Eijkman Oxford Clinical Research Unit; Bamrasnaradura Infectious Disease Institute; Chest Disease Institute Nonthaburi; Mahidol Oxford Research Unit Bangkok; Queen Sirikit National Institute of Child Health; Mahidol University; National University Hospital, Singapore; Children's Hospital 1; Children's Hospital 2; UCL; National Hospital for Tropical Diseases
    Objective: To investigate the validity of recommendations in treatment guidelines to use higher than approved doses of oseltamivir in patients with severe influenza. Design: Double blind randomised trial. Setting: Thirteen hospitals in Indonesia, Singapore, Thailand, and Vietnam. Participants: Patients aged ≥1 year admitted to hospital with confirmed severe influenza. Interventions: Oral oseltamivir at double dose (150 mg twice a day/paediatric equivalent) versus standard dose (75 mg twice a day/paediatric equivalent). Main outcome measure: Viral status according to reverse transcriptase polymerase chain reaction (RT-PCR) for influenza RNA in nasal and throat swabs on day five. Results: Of 326 patients (including 246 (75.5%) children aged <15), 165 and 161 were randomised to double or standard dose oseltamivir, respectively. Of these, 260 (79.8%) were infected with influenza virus A (133 (40.8%) with A/H3N2, 72 (22.1%) with A/H1N1-pdm09, 38 (11.7%) with seasonal A/H1N1, 17 (5.2%) with A/H5N1) and 53 (16.2%) with influenza virus B. A further 3.9% (13) were false positive by rapid antigen test (negative by RT-PCR and no rise in convalescent haemagglutination inhibition titers). Similar proportions of patients were negative for RT-PCR on day five of treatment: 115/159 (72.3%, 95% confidence interval 64.9% to 78.7%) double dose recipients versus 105/154 (68.2%, 60.5% to 75.0%) standard dose recipients; difference 4.2% (-5.9 to 14.2); P=0.42. No differences were found in clearance of virus in subgroup analyses by virus type/subtype, age, and duration of illness before randomisation. Mortality was similar: 12/165 (7.3%, 4.2% to 12.3%) in double dose recipients versus 9/161 (5.6%, 3.0% to 10.3%) in standard dose recipients. No differences were found between double and standard dose arms in median days on supplemental oxygen (3 (interquartile range 2-5) v 3.5 (2-7)), in intensive care (4.5 (3-6) v 5 (2-11), and on mechanical ventilation (2.5 (1-16) v 8 (1-16)), respectively. No important differences in tolerability were found. Conclusions: There were no virological or clinical advantages with double dose oseltamivir compared with standard dose in patients with severe influenza admitted to hospital. Registration: Clinical Trials NCT00298233.
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    Effect of high-dose fluconazole on QT interval in patients with human immunodeficiency virus (HIV)-associated cryptococcal meningitis
    (2009-11-01) Weerawat Manosuthi; Somnuek Sungkanuparph; Thanomsak Anekthananon; Khuanchai Supparatpinyo; Tracy L. Nolen; Louise O. Zimmer; Peter G. Pappas; Robert A. Larsen; Scott G. Filler; Ploenchan Chetchotisakd; Bamrasnaradura Infectious Diseases Institute; Mahidol University; Chiang Mai University; Rho Federal Systems Division, Inc.; University of Alabama; Keck School of Medicine of USC; David Geffen School of Medicine at UCLA; Khon Kaen University
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    Effectiveness of non-nucleoside reverse-transcriptase inhibitor-based antiretroviral therapy in women previously exposed to a single intrapartum dose of nevirapine: A multi-country, prospective cohort study
    (2010-02-01) Jeffrey S A Stringer; Michelle S. McConnell; James Kiarie; Omotayo Bolu; Thanomsak Anekthananon; Tavatchai Jariyasethpong; Dara Potter; Winnie Mutsotso; Craig B. Borkowf; Dorothy Mbori-Ngacha; Peter Muiruri; John Odero Ong'ech; Isaac Zulu; Lungowe Njobvu; Bongkoch Jetsawang; Sonal Pathak; Marc Bulterys; Nathan Shaffer; Paul J. Weidle; Centre for Infectious Disease Research in Zambia; Thailand Ministry of Public Health; Centers for Disease Control and Prevention; Kenyatta National Hospital; University of Nairobi; Mahidol University; Rajavithi Hospital; CDC Global AIDS Program; Global AIDS Program; National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; University Teaching Hospital Lusaka; Northrop Grumman corporation
    Background: Intrapartum and neonatal single-dose nevirapine (NVP) reduces the risk of mother-to-child HIV transmission but also induces viral resistance to non-nucleoside reverse transcriptase inhibitor (NNRTI) drugs. This drug resistance largely fades over time. We hypothesized that women with a prior single-dose NVP exposure would have no more than a 10% higher cumulative prevalence of failure of their NNRTI-containing antiretroviral therapy (ART) over the first 48 wk of therapy than would women without a prior exposure. Methods and Findings: We enrolled 355 NVP-exposed and 523 NVP-unexposed women at two sites in Zambia, one site in Kenya, and two sites in Thailand into a prospective, non-inferiority cohort study and followed them for 48 wk on ART. Those who died, discontinued NNRTI-containing ART, or had a plasma viral load ≥400 copies/ml at either the 24 wk or 48 wk study visits and confirmed on repeat testing were characterized as having failed therapy. Overall, 114 of 355 NVP-exposed women (32.1%) and 132 of 523 NVP-unexposed women (25.2%) met criteria for treatment failure. The difference in failure rates between the exposure groups was 6.9% (95% confidence interval [CI] 0.8%-13.0%). The failure rates of women stratified by our predefined exposure interval categories were as follows: 47 of 116 women in whom less than 6 mo elapsed between exposure and starting ART failed therapy (40%; p<0.001 compared to unexposed women); 25 of 67 women in whom 7-12 mo elapsed between exposure and starting ART failed therapy (37%; p = 0.04 compared to unexposed women); and 42 of 172 women in whom more than 12 mo elapsed between exposure and starting ART failed therapy (24%; p = 0.82 compared to unexposed women). Locally weighted regression analysis also indicated a clear inverse relationship between virologic failure and the exposure interval. Conclusions: Prior exposure to single-dose NVP was associated with an increased risk of treatment failure; however, this risk seems largely confined to women with a more recent exposure. Women requiring ART within 12 mo of NVP exposure should not be prescribed an NNRTI-containing regimen as first-line therapy.
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    Efficacy and safety of single and double doses of ivermectin versus 7-day high dose albendazole for chronic strongyloidiasis
    (2011-05-01) Yupin Suputtamongkol; Nalinee Premasathian; Kid Bhumimuang; Duangdao Waywa; Surasak Nilganuwong; Ekkapun Karuphong; Thanomsak Anekthananon; Darawan Wanachiwanawin; Saowaluk Silpasakorn; Mahidol University
    Background: Strongyloidiasis, caused by an intestinal helminth Strongyloides stercoralis, is common throughout the tropics. It remains an important health problem due to autoinfection, which may result in hyperinfection and disseminated infection in immunosuppressed patients, especially patients receiving chemotherapy or corticosteroid treatment. Ivermectin and albendazole are effective against strongyloidiasis. However, the efficacy and the most effective dosing regimen are to be determined. Methods: A prospective, randomized, open study was conducted in which a 7-day course of oral albendazole 800 mg daily was compared with a single dose (200 microgram/kilogram body weight), or double doses, given 2 weeks apart, of ivermectin in Thai patients with chronic strongyloidiasis. Patients were followed-up with 2 weeks after initiation of treatment, then 1 month, 3 months, 6 months, 9 months, and 1 year after treatment. Combination of direct microscopic examination of fecal smear, formol-ether concentration method, and modified Koga agar plate culture were used to detect strongyloides larvae in two consecutive fecal samples in each follow-up visit. The primary endpoint was clearance of strongyloides larvae from feces after treatment and at one year follow-up. Results: Ninety patients were included in the analysis (30, 31 and 29 patients in albendazole, single dose, and double doses ivermectin group, respectively). All except one patient in this study had at least one concomitant disease. Diabetes mellitus, systemic lupus erythrematosus, nephrotic syndrome, hematologic malignancy, solid tumor and human immunodeficiency virus infection were common concomitant diseases in these patients. The median (range) duration of follow-up were 19 (2-76) weeks in albendazole group, 39 (2-74) weeks in single dose ivermectin group, and 26 (2-74) weeks in double doses ivermectin group. Parasitological cure rate were 63.3%, 96.8% and 93.1% in albendazole, single dose oral ivermectin, and double doses of oral ivermectin respectively (P = 0.006) in modified intention to treat analysis. No serious adverse event associated with treatment was found in any of the groups. Conclusion/Significance: This study confirms that both a single, and a double dose of oral ivermectin taken two weeks apart, is more effective than a 7-day course of high dose albendazole for patients with chronic infection due to S. stercoralis. Double dose of ivermectin, taken two weeks apart, might be more effective than a single dose in patients with concomitant illness. © 2011 Suputtamongkol et al.
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    Estimated economic losses of hospitalized AIDS patients at Siriraj Hospital from January 2003 to December 2003: Time for aggressive voluntary counseling and HIV testing
    (2005-03-01) Winai Ratanasuwan; Thanomsak Anekthananon; Wichai Techasathit; Yong Rongrungruang; Areeaue Sonjai; Surapol Suwanagool; Mahidol University
    This retrospective study was performed to explore the pattern of adult HIV-infected patients admitted to Siriraj Hospital from January 2003 to December 2003 and estimated the economic losses of these patients. Two hundred and forty four medical records were available for review. The proportion of male to female was 2 to 1. Mean age of patients was 36.64 ± 9.72 years. The mean CD4 count among 112 patients was 82.79 ± 96.49 cell/mm 3. One hundred and twenty four (50.82%) were newly diagnosed of HIV infection. The three most common opportunistic infections were Tuberculosis (42.62%), Pneumocystis carinii pneumonia (14.75%), and cryptococcosis (13.11%). The mean duration of admission was 15.72 ± 15.11 days. The mean expense per admission was 38, 194.58 ± 32, 354.86 Baht. Fifty four patients (22.13%) died during admission. The mean income of these patients was 3, 903.5 ± 3, 841.42 baht per month. The estimated economic losses of 54 patients who died during admission including medical care expense and income losses due to premature death was 69,769,739.32 baht. However, the expected medical expense of antiretroviral medications in these 54 patients if they had been diagnosed earlier and their lives had been saved would have been 42,214,608 baht. Therefore, vigorous voluntary counseling and HIV testing in patients aged 13-70 years when they have any risk factors for HIV infection regardless of symptoms might be more cost effective than diagnosis when they get sick.
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    Factors associated with human immunodeficiency virus transmission in heterosexual couples
    (Mahidol University. Mahidol University Library and Knowledge Center, 2001) Monthichar Chenphanitsub; Supachai Ratanamaneechat; Wichai Techasathit; Thanomsak Anekthananon
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    Guidelines for antiretroviral therapy in HIV-1 infected adults and adolescents 2014, Thailand
    (2015-04-24) Weerawat Manosuthi; Sumet Ongwandee; Sorakij Bhakeecheep; Manoon Leechawengwongs; Kiat Ruxrungtham; Praphan Phanuphak; Narin Hiransuthikul; Winai Ratanasuwan; Ploenchan Chetchotisakd; Woraphot Tantisiriwat; Sasisopin Kiertiburanakul; Anchalee Avihingsanon; Akechittra Sukkul; Thanomsak Anekthananon; Thailand Ministry of Public Health; National Health Security Office; Thai AIDS Society; Chulalongkorn University; The HIV Netherlands Australia Thailand Research Collaboration; Mahidol University; Khon Kaen University; Srinakharinwirot University
    © Manosuthi et al.; licensee BioMed Central. New evidence has emerged regarding when to commence antiretroviral therapy (ART), optimal treatment regimens, management of HIV co-infection with opportunistic infections, and management of ART failure. The 2014 guidelines were developed by the collaborations of the Department of Disease Control, Ministry of Public Health (MOPH) and the Thai AIDS Society (TAS). One of the major changes in the guidelines included recommending to initiating ART irrespective of CD4 cell count. However, it is with an emphasis that commencing HAART at CD4 cell count above 500 cell/mm3 is for public health, in term of preventing HIV transmission and personal benefit. In tuberculosis co-infected patients with CD4 cell counts ≤50 cells/mm3 or with CD4 cell counts >50 cells/mm3 who have severe clinical disease, ART should be initiated within 2 weeks of starting tuberculosis treatment. The preferred initial ART regimen in treatment naïve patients is efavirenz combined with tenofovir and emtricitabine or lamivudine. Plasma HIV viral load assessment should be done twice a year until achieving undetectable results; and will then be monitored once a year. CD4 cell count should be monitored every 6 months until CD4 cell count ≥350 cells/mm3 and with plasma HIV viral load <50 copies/mL; then it should be monitored once a year afterward. HIV drug resistance genotypic test is indicated when plasma HIV viral load >1,000 copies/mL while on ART. Ritonavir-boosted lopinavir or atazanavir in combination with optimized two nucleoside-analogue reverse transcriptase inhibitors is recommended after initial ART regimen failure. Long-term ART-related safety monitoring has also been included in the guidelines.
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    Guidelines for antiretroviral therapy in HIV-1 infected adults and adolescents: The recommendations of the thai AIDS society (TAS) 2008
    (2008-12-01) Somnuek Sungkanuparph; Thanomsak Anekthananon; Narin Hiransuthikul; Chureeratana Bowonwatanuwong; Khuanchai Supparatpinyo; Piroon Mootsikapun; Ploenchan Chetchotisakd; Sasisopin Kiertiburanakul; Somsit Tansuphaswadikul; Wanchai Buppanharun; Weerawat Manosuthi; Wichai Techasathit; Winai Ratanasuwan; Woraphot Tantisiriwat; Surapol Suwanagool; Manoon Leechawengwongs; Kiat Ruxrungtham; Mahidol University; Chulalongkorn University; Chonburi Regional Hospital; Chiang Mai University; Khon Kaen University; Thailand Ministry of Public Health; Faculty of Medicine; Vichaiyut Hospital; The HIV Netherlands Australia Thailand Research Collaboration
    Background: More than 100,000 patients have been treated, since the implementation of the National Universal Coverage for antiretroviral therapy (ART) in Thailand. Although there are several comprehensive guidelines available internationally, there is a need to have guidelines that can be implemented in Thailand. Material and Method: The guidelines were developed by a panel of 17 members who are the experts on HIV research and/or HIV patient care and appointed without incentive by the Thai AIDS Society (TAS). The recommendations were based on evidences from the published studies and availability of antiretroviral agents. Published studies that are relevant and applicable to Thailand in particular have been taken into consideration. Results: The recommendations include: when to start ART; what to start; how to monitor the therapy; adverse effects and its management; diagnosis of treatment failure; and antiretroviral treatment options in patients with treatment failure. ART in special circumstances, i.e. patients with co-infection of tuberculosis or hepatitis B virus, is also included. Appropriate level of CD4+T-cell count to start ART among Thai patients has been considered carefully. The authors recommend to start ART at CD4+T-cell count < 200 cells/mm3. Conclusion: ART should be initiated in adults and adolescents HIV-1 infected patients with a history of HIV-related illness or AIDS or with a CD4+T-cell count < 200 cells/mm3. For treatment-naive patients, the preferred initial therapy is a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen. CD4+T-cell count and viral load should be monitored for at least twice and once a year, respectively. Proper management of antiretroviral-related toxicity and enhancement of adherence are crucial for the long-term success of ART.
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    High rate multiple drug resistances in HIV-infected patients failing nonnucleoside reverse transcriptase inhibitor regimens in Thailand, where subtype A/E is predominant
    (2006-12-01) Ploenchan Chetchotisakd; Siriluck Anunnatsiri; Sasisopin Kiertiburanakul; Ruengpung Sutthent; Thanomsak Anekthananon; Chureeratana Bowonwatanuwong; Boonchai Kowadisaiburana; Khuanchai Supparatpinyo; Manassinee Horsakulthai; Sanchai Chasombat; Kiat Ruxrungtham; Khon Kaen University; Mahidol University; Chonburi Regional Hospital; Bamrasnaradura Infectious Disease Institute; Chiang Mai University; Thailand Ministry of Public Health; Chulalongkorn University; The HIV Netherlands Australia Thailand Research Collaboration
    The prevalence of drug resistance was determined among 64 HIV-infected Thai patients who were failed while receiving nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens. Eighty-nine percent of patients had 1 or more NNRTI mutation resistances. Almost all patients had resistance to at least 1 nucleoside reverse transcriptase inhibitor (NRTI), and 42% had multiple-NRTI resistance. © 2006 Sage Publications.
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    HIV Infection/Acquired Immunodeficiency Syndrome at Siriraj Hospital, 2002: Time for Secondary Prevention
    (2004-02-01) Thanomsak Anekthananon; Wichai Techasathit; Surapol Suwanagool; Winai Ratanasuwan; Yong Rongrungruang; Mahidol University
    The authors retrospectively reviewed the medical records of HIV/AIDS patients who were admitted to the medical service, Siriraj Hospital from January 1, 2002 through December 31, 2002. Demographics, CD4 lymphocyte counts, discharge diagnoses, the incidence of Pneumocystis carinii pneumonia (PCP), cerebral toxoplasmosis and cryptococcosis in patients who received and did not receive appropriate chemoprophylaxis against those opportunistic infections when indicated, and outcome of the patients were collected. Three hundred medical records of 286 HIV/AIDS patients were available for review. One hundred and seventy two patients (60.1%) were male. Mean age of the patients was 36.8 ± 9.91 years (range 14-74). The mean CD4 lymphocyte count that was determined in 165 patients was 74.7 ± 134.21 cells/mm3 (range 0-894). Of the 300 admissions, 36 per cent were newly diagnosed HIV infection. Only 23 (7.7%) patients had received antiretroviral drugs at the time of hospitalization. The leading HIV-related diseases were tuberculosis (29.3%), Pneumocystis carinii pneumonia (18.7%), and cryptococcosis (15.7%). The rest of them included cytomegalovirus diseases (6.3%), lymphoma (6.3%), Salmonella bacteremia (6%), cerebral toxoplasmosis (5.7%), cryptosporidiosis (5.3%), disseminated Mycobacterium avium complex infection (1.0%), extrapulmonary histoplasmosis (1.0%), Candida esophagitis (1.0%), progressive multifocal leukoencephalopathy (1.0%), and rhodococcosis (0.7%). Among those for whom HIV infection was established and chemoprophylaxis for PCP, cerebral toxoplasmosis and cryptococcosis were indicated, 9.8 per cent vs 28.2 per cent, 3.6 per cent vs 5.1 per cent, and 10 per cent vs 15.2 per cent of whom received and did not receive the appropriate chemoprophylaxis developed PCP, cerebral toxoplasmosis and cryptococcosis respectively. One hundred and ninety (63.3%) patients were alive at discharge, 84 (28.0%) had died, 21 (7%) were referred to other hospitals, and 5 (1.7%) left hospital against medical advice. The mortality rate in newly diagnosed HIV and in known HIV without antiretroviral treatment were comparable but much lower in known HIV-infected patients who received antiretroviral therapy. Secondary prevention by detection of HIV-infected patients while they are asymptomatic and providing them with appropriate chemoprophylaxis against specific opportunistic infections as well as apropriate antiretroviral treatment would decrease morbidity, mortality, and improve the quality of life of HIV-infected patients in Thailand.
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    Implementation and assessment of a prevention with positives intervention among people living with HIV at five hospitals in Thailand
    (2017-02-01) Benjamas Baipluthong; Thanomsak Anekthananon; Warangkana Munsakul; Supunnee Jirajariyavej; Suvanna Asavapiriyanont; Ubonsri Hancharoenkit; Anuvat Roongpisuthipong; Sarika Pattanasin; Michael Martin; Lisa Guntamala; Rangsima Lolekha; Centers for Disease Control (CDC), Thailand Field Station; Mahidol University; Vajira Hospital; Taksin Hospital; Rajavithi Hospital; Wieng Pa Pao Hospital; Thailand Ministry of Public Health
    © This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication. Background We implemented a hospital-based prevention with positives (PwP) intervention among people living with HIV (PLHIV) that included HIV transmission risk screening, short HIV prevention messages, family planning, HIV disclosure counseling, and partner HIV testing at five hospitals in Thailand. We assessed changes in sexual risk behaviors among PLHIV who received the PwP services at the hospitals. Methods From January 2008-March 2009, we systematically selected a subset of PLHIV receiving care at the five hospitals to offer participation in the PwP intervention. We collected demographic, risk behavior, and laboratory data using a standardized questionnaire. We analyzed data from PLHIV who completed at least four visits, using generalized estimating equations to identify baseline participant characteristics that were associated with adopting sexual practices less likely to be associated with HIV transmission during follow-up. Results A total of 830 PLHIV were interviewed and 756 (91.1%) completed four visits. The median age of these 756 participants was 37 years, 400 (52.9%) were women, and 475 (62.8%) had a steady partner. At baseline, 353 (74.3%) of the steady partners had been tested for HIV and 132 (37.4%) had tested negative. Among the 756 PLHIV, 427 (56.5%) reported having sex in the 3 months before enrollment and 413 (54.6%) in the 3 months before the fourth visit. The proportion reporting having vaginal or anal sex without a condom decreased from 20.8% at baseline to 5.1% at the fourth visit (p<0.001). Factors associated (p<0.05) with abstinence or 100% condom use at follow-up visits included: completing ô two visits, being diagnosed with HIV for longer than 3 months, and receiving HIV prevention messages from a doctor (versus a nurse or counselor). Conclusion Safe sex behaviors increased among PLHIV receiving PwP services, suggesting that expansion of hospital-based PwP services may reduce the number of new HIV infections in Thailand.
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    Nevirapine plasma concentrations and concomitant use of rifampin in patients coinfected with HIV-1 and tuberculosis
    (2005-12-01) Reshma S. Autar; Ferdinand W.N.M. Wit; Jongkol Sankote; Apicha Mahanontharit; Thanomsak Anekthananon; Piroon Mootsikapun; Khanjtta Sujaikaew; David A. Cooper; Joep M.A. Lange; Praphan Phanuphak; Kiat Ruxrungtham; David M. Burger; The HIV Netherlands Australia Thailand Research Collaboration; University of Amsterdam; Mahidol University; Khon Kaen University; Kirby Institute; University of New South Wales (UNSW) Australia; PharmAccess Foundation; Chulalongkorn University; Radboud University Nijmegen Medical Centre
    Objectives: In countries with high numbers of HIV/tuberculosis coinfection nevirapine and rifampin are used extensively. However, limited data are available about whether or not nevirapine and rifampin can be safely co-administered without the plasma concentration of nevirapine falling below therapeutic levels. Methods: Blood samples for determination of nevirapine plasma concentrations were collected from patients using nevirapine 200 mg twice daily with or without concomitant rifampin. Bivariate and multivariate linear regression models were used to investigate factors possibly related to nevirapine concentrations. Results: We received 74 blood samples from patients using nevirapine plus rifampin, and collected blood samples from an equal number of controls using nevirapine only. Groups were similar for age, gender, weight, height and body mass index (BMI). In the rifampin group the mean nevirapine concentration was 5.47 ± 2.66mg/l, whereas in the control group the mean nevirapine concentration was 8.72 ± 3.98 mg/l. In the rifampin group seven nevirapine trough concentrations were low (<3.1 mg/l), while in the control group two patients had low nevirapine trough concentrations (P=0.164). In the multivariate linear regression analysis, corrected for time after drug intake, the use of rifampin was significantly (P<0.001) associated with lower nevirapine plasma concentrations, whereas higher BMI reached borderline significance (P=0.065). Conclusion: Although nevirapine plasma concentrations were 3.3 mg/l lower when co-administered with rifampin, still more than 86% of these patients had nevirapine plasma concentrations >3.1 mg/l. Our results suggest that from a pharmacological point of view the majority of Thai coinfected patients, who have low BMIs, reach nevirapine plasma concentrations that are adequate for treatment of HIV. However this can only be undertaken if nevirapine plasma concentration monitoring is available and can be closely followed. © 2005 International Medical Press.
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    Safety and efficacy of a simplified fixed-dose combination of stavudine, lamivudine and nevirapine (GPO-VIR®) for the treatment of advanced HIV-infected patients: A 24-week study
    (2004-07-01) Thanomsak Anekthananon; Winai Ratanasuwan; Wichai Techasathit; Areeaue Sonjai; Surapol Suwanagool; Mahidol University; Faculty of Medicine, Siriraj Hospital, Mahidol University
    Objective: To determine the efficacy and safety of the fixed-dose combination of stavudine (d4T), lamivudine (3TC) and nevirapine (NVP) in the treatment of antiretroviral naïve HIV-infected Thai adults. Patients And Method: An open-label, single arm trial was conducted. Baseline clinical assessment and blood test was done on 101 antiretroviral naïve HIV-infected patients, who then received a fixed dose combination of d4T, 3TC and NVP (GPO-VIR®, Thai Government Pharmaceutical Organization, Bangkok, Thailand). Nevirapine was given as 200 mg once daily for the first 2 weeks. The patients were followed up at 2, 4, 8, 12 and 24 weeks. A CD4 cell count and HIV-RNA assay were done at 12 and 24 weeks. Results: One hundred and one patients were enrolled. The mean baseline CD4 cell count and mean HIV RNA were 58.7 (57.7) cells/mm3 and 5.3 (0.5) log10 copies/mL respectively. At week 24th, the mean decrease in log HIV RNA was 3.6 (0.7) log10 copies/mL [P < 0.001; 95% confidence interval (CI), 2.70-3.03]. Eighty one (80.2%) patients had HIV RNA < 400 copies/mL by intention-to-treat analysis (ITT) and 97.6% had HIV RNA < 400 copies/mL by on-treatment analysis (OT). Sixteen (84.2%) patients with baseline HIV RNA ≤ 100,000 copies/mL and 65 (82.3%) patients with baseline HIV RNA > 100,000 copies/mL had viral load < 400 copies/mL by ITT (P = 0.842; 95% CI, -20.9%-16.2%). Sixteen (94.1%) patients with baseline HIV RNA ≤ 100,000 copies/mL and 65 (98.5%) patients with baseline HIV RNA > 100,000 copies/mL had viral load < 400 copies/mL by OT (P = 0.295; 95% CI, -25.5%-3.8%). The mean CD4 cell count at week 24 was 155.1 (89.0) cells/mm3s (range 13-402). The mean increase in CD4 cell count from baseline was 96.5 (63.5) cells/mm3 (P < 0.001). A total of 12% of the patients receiving d4T + 3TC + NVP developed skin rashes. Grade 3 or 4 hepatotoxicity was recognized in 7% of the patients. Conclusion: Fixed-dose combination of d4T + 3TC + NVP (GPO-VIR®) is safe, well tolerated and effective in increasing CD4 cell counts and suppression of HIV RNA at 24 weeks in advanced HIV-infected patients in Thailand.
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    Two-year safety and tolerability study of enfuvertide use in salvage therapy of Thai HIV-1 experienced cases
    (2011-03-01) Wisit Prasithsirikul; Mattana Hanvanich; Surapol Suwanagool; Winai Ratanasuwan; Thanomsak Anekthananon; Wichai Techasathit; Khuanchai Supparatpinyo; Asda Viphagool; Thailand Ministry of Public Health; Chulalongkorn University; Mahidol University; Chiang Mai University; Bamrungrad International Hospital
    Objective: To assess safety and tolerability of enfuvirtide, an antiretroviral, in Thai patients with advanced HIV-1 disease who have received antiretroviral treatment and failed on regimens that contain at least one of each antiretroviral (ARV) classes (PIs, NRTIs, and NNRTIs), or who have intolerance to previous antiretroviral regimens. Material and Method: An open-label non-comparative study of enfuvirtide used in salvage regimens along with the backbone antiretroviral therapy of choice in Thai HIV-1 experienced cases that have been treated with at least one of each available ARV classes. Results: Twenty-three patients were recruited from five participating centers. Seventeen patients (74%) completed 96 weeks of the treatment. Six patients prematurely withdrew from the present study in which three expired from HIV related complications, two withdrew consents, and one from adverse event. The most common adverse event is injection site reactions, which occurred in 22 patients. The manifestations and intensity varied from rash, erythema, edema, pain, induration, and bleeding at the injection sites, to inflammatory nodules. Most of the patients tolerated the treatment well. Enfuvirtide administered along with other antiretroviral combination provided a good control of the disease. Conclusion: Enfuvirtide was well tolerated by Thai patients who participated in the present study. The adverse events did not compromise the patient compliance.