Browsing by Author "V. Sirisanthana"

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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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    Impact of low-level viraemia on virological failure among Asian children with perinatally acquired HIV on first-line combination antiretroviral treatment: a multicentre, retrospective cohort study
    (2020-07-01) Tavitiya Sudjaritruk; Sirinya Teeraananchai; Azar Kariminia; Keswadee Lapphra; Nagalingeswaran Kumarasamy; Moy S. Fong; Rawiwan Hansudewechakul; Torsak Bunupuradah; Penh Sun Ly; Revathy A. Nallusamy; Annette H. Sohn; Virat Sirisanthana; J. Tucker; N. Kumarasamy; C. Ezhilarasi; A. Kinikar; V. Mave; S. Nimkar; N. Kurniati; D. Muktiarti; S. M. Fong; M. Lim; F. Daut; P. Mohamad; T. J. Mohamed; R. Nallusamy; V. Sirisanthana; L. Aurpibul; P. Ounchanum; R. Hansudewechakul; S. Denjanta; A. Kongphonoi; P. Lumbiganon; P. Kosalaraksa; P. Tharnprisan; T. Udomphanit; G. Jourdain; T. Puthanakit; S. Anugulruengkit; W. Jantarabenjakul; R. Nadsasarn; K. Chokephaibulkit; W. Phongsamart; S. Sricharoenchai; K. H. Truong; Q. T. Du; C. H. Nguyen; V. C. Do; T. M. Ha; L. V. Nguyen; D. T.K. Khu; L. T. Nguyen; O. N. Le; A. H. Sohn; J. L. Ross; T. Suwanlerk; M. G. Law; A. Kariminia; VHS Medical Centre India; Thai Red Cross Agency; Kirby Institute; Kasetsart University; Faculty of Medicine, Siriraj Hospital, Mahidol University; Chiang Mai University; National Centre for HIV/AIDS; Foundation for AIDS Research; Penang Hospital; Chiangrai Prachanukroh Hospital; Hospital Likas
    © 2020 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society Introduction: The clinical relevance of low-level viraemia (LLV) and virological outcomes among children living with HIV (CLHIV) remains controversial. This study aimed to determine the impact of LLV on virological failure (VF) among Asian CLHIV on first-line combination antiretroviral therapy (cART). Methods: CLHIV aged <18 years, who were on first-line cART for ≥12 months, and had virological suppression (two consecutive plasma viral load [pVL] <50 copies/mL) were included. Those who started treatment with mono/dual antiretroviral therapy, had a history of treatment interruption >14 days, or received treatment and care at sites with a pVL lower limit of detection >50 copies/mL were excluded. LLV was defined as a pVL 50 to 1000 copies/mL, and VF as a single pVL >1000 copies/mL. Baseline was the time of the second pVL < 50 copies/mL. Cox proportional hazards models were performed to assess the association between LLV and VF. Results: From January 2008 to September 2016, 508 CLHIV (55% female) were eligible for the study. At baseline, the median age was 9.6 (IQR: 7.0 to 12.3) years, cART duration was 1.4 (IQR: 1.3 to 1.8) years, 97% of CLHIV were on non-nucleoside reverse transcriptase inhibitor-based regimens, and the median CD4 was 25% (IQR: 20% to 30%). Over a median follow-up time of 6.0 (IQR: 3.1 to 8.9) years from baseline, 86 CLHIV (17%) had ever experienced LLV, of whom 32 (37%) had multiple LLV episodes. Female sex, living in Malaysia (compared to Cambodia), having family members other than biological parents/grandparents as a primary caregiver, and baseline CD4 < 25% increased risk of LLV. Overall, 115 children (23%) developed VF, corresponding to a rate of 4.0 (95%CI: 3.4 to 4.9) per 100 person-years of follow-up (PYFU). VF was greater among children who had ever experienced LLV compared with those who maintained virological suppression throughout the study period (8.9 vs. 3.3 per 100 PYFU; p < 0.001). In multivariable analyses, ever experiencing LLV was associated with increased risk of subsequent VF (adjusted hazard ratio: 3.01; 95%CI: 1.97 to 4.60). Conclusions: LLV increased the risk of subsequent VF among Asian CLHIV who had previously been suppressed on first-line cART. Adherence interventions and additional targeted pVL monitoring may be warranted among children with LLV to facilitate early detection of VF.
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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.
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    Use and Outcomes of Antiretroviral Monotherapy and Treatment Interruption in Adolescents With Perinatal HIV Infection in Asia
    (2019-11-01) Adam W. Bartlett; Pagakrong Lumbiganon; Nia Kurniati; Tavitiya Sudjaritruk; Thahira J. Mohamed; Rawiwan Hansudewechakul; Penh S. Ly; Khanh H. Truong; Thanyawee Puthanakit; Lam V. Nguyen; Kulkanya Chokephaibulkit; Viet C. Do; Nagalingeswaran Kumarasamy; Nik Khairulddin Nik Yusoff; Moy S. Fong; Dewi K. Watu; Revathy Nallusamy; Annette H. Sohn; Matthew G. Law; V. Khol; J. Tucker; E. Chandrasekaran; D. K. Wati; D. Vedaswari; I. B. Ramajaya; D. Muktiarti; M. Lim; F. Daut; P. Mohamad; M. R. Drawis; K. C. Chan; V. Sirisanthana; L. Aurpibul; P. Ounchanum; S. Denjanta; A. Kongphonoi; P. Kosalaraksa; P. Tharnprisan; T. Udomphanit; G. Jourdain; S. Anugulruengkit; W. Jantarabenjakul; R. Nadsasarn; K. Lapphra; W. Phongsamart; S. Sricharoenchai; Q. T. Du; C. H. Nguyen; T. M. Ha; V. T. An; D. T.K. Khu; A. N. Pham; L. T. Nguyen; O. N. Le; J. L. Ross; C. Sethaputra; A. Kariminia; VHS Medical Centre India; National Hospital of Pediatrics Hanoi; Universitas Udayana; Universitas Indonesia; Chulalongkorn University; Kirby Institute; Faculty of Medicine, Khon Kaen University; Kuala Lumpur Hospital; Faculty of Medicine, Siriraj Hospital, Mahidol University; Chiang Mai University; Children's Hospital 2; National Center for HIV/AIDS; Children's Hospital 1; TREAT Asia/amfAR-The Foundation for AIDS Research; Penang Hospital; Chiangrai Prachanukroh Hospital; Hospital Likas; Hospital Raja Perempuan Zainab II
    © 2019 Society for Adolescent Health and Medicine Purpose: Antiretroviral monotherapy and treatment interruption are potential strategies for perinatally HIV-infected adolescents (PHIVA) who face challenges maintaining effective combination antiretroviral therapy (ART). We assessed the use and outcomes for adolescents receiving monotherapy or undergoing treatment interruption in a regional Asian cohort. Methods: Regional Asian data (2001–2016) were analyzed to describe PHIVA who experienced ≥2 weeks of lamivudine or emtricitabine monotherapy or treatment interruption and trends in CD4 count and HIV viral load during and after episodes. Survival analyses were used for World Health Organization (WHO) stage III/IV clinical and immunologic event-free survival during monotherapy or treatment interruption, and a Poisson regression to determine factors associated with monotherapy or treatment interruption. Results: Of 3,448 PHIVA, 84 (2.4%) experienced 94 monotherapy episodes, and 147 (4.3%) experienced 174 treatment interruptions. Monotherapy was associated with older age, HIV RNA >400 copies/mL, younger age at ART initiation, and exposure to ≥2 combination ART regimens. Treatment interruption was associated with CD4 count <350 cells/μL, HIV RNA ≥1,000 copies/mL, ART adverse event, and commencing ART age ≥10 years compared with age <3 years. WHO clinical stage III/IV 1-year event-free survival was 96% and 85% for monotherapy and treatment interruption cohorts, respectively. WHO immunologic stage III/IV 1-year event-free survival was 52% for both cohorts. Those who experienced monotherapy or treatment interruption for more than 6 months had worse immunologic and virologic outcomes. Conclusions: Until challenges of treatment adherence, engagement in care, and combination ART durability/tolerability are met, monotherapy and treatment interruption will lead to poor long-term outcomes.