Time filter

Source Type

Mueang Nonthaburi, Thailand

Khawcharoenporn T.,Thammasat University | Apisarnthanarak A.,Thammasat University | Manosuthi W.,Bamrasnaradura Infectious Diseases Institute | Sungkanuparph S.,Mahidol University | Mundy L.M.,LM Mundy LLC
International Journal of Tuberculosis and Lung Disease | Year: 2012

SETTING: Human immunodeficiency virus (HIV) clinics at two Thai tertiary care medical centres. OBJECTIVES: To evaluate the efficacy of tuberculin skin test (TST) guided isoniazid preventive therapy (IPT) in combination with antiretroviral therapy (ART) in the prevention of tuberculosis (TB). DESIGN: A 4-year prospective comparative study of patients at two HIV clinics: one performed TST at enrolment and, if positive, prescribed IPT (IPT group), while the other did not perform TST (non-IPT group). RESULTS: There were 200 patients included in each group. Baseline characteristics and drop-out rates were similar in both groups. The incidence of pulmonary TB over 4 years was not significantly different between the IPT and non-IPT groups (0.80 cases vs. 1.76 per 100 person-years [py], P = 0.13). However, the incidence of pulmonary TB in the non-IPT group was significantly higher during the first 6 months (8.60 vs. 0 cases/100 py, P = 0.01) and among patients with initial CD4 < 200 cells/μl (9.41 vs. 0 cases/100 py, P = 0.02). The survival analyses demonstrated a protective effect of IPT (χ2 = 3.66, P = 0.04) for early TB. CONCLUSIONS: Benefit of IPT plus ART was evident only in the first 6 months of care. These findings suggest that TST-guided IPT should be routinely provided for HIV-infected patients after initial entry into medical care. © 2012 The Union. Source

Siripongpreeda N.,Bamrasnaradura Infectious Diseases Institute
Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2010

This study assessed clinical differences between invasive pneumococcal disease (IPD) caused by penicillin-resistant and penicillin-sensitive Streptococcus pneumoniae. Patients with IPD confirmed during January 1996-December 2007 at three hospitals were included. Clinical characteristics and outcomes were compared between patients infected with penicillin-resistant Streptococcus pneumoniae (PRSP) and penicillin-sensitive Streptococcus pneumoniae (PSSP). Sixty-nine patients with IPD were identified during the study period, 20 (29%) of whom were infected with PRSP and 49 (71%) with PSSP. Sex, mean age, underlying diseases and seasonal variation did not differ statistically between the two groups. No significant differences were identified in clinical course as measured by time until defervescence, duration of hospitalization and clinical outcome. Minimum inhibitory concentrations (MIC) for other antibiotics were determined; 20% and 10% of PRSP isolates were nonsusceptible to cephalosporins and meropenem, respectively, but all isolates were sensitive to vancomycin. There were no significant differences identified in the clinical epidemiology of lPD cases caused by PRSP and PSSP. Source

Wongsawat J.,Bamrasnaradura Infectious Diseases Institute
Journal of the Medical Association of Thailand = Chotmaihet thangphaet | Year: 2010

The pneumococcal conjugate vaccines (PCVs) have demonstrated good safety profile and efficacy against invasive pneumococcal diseases (IPD) caused by the serotypes included in the vaccines. The PCV also benefit to the unvaccinated children and adults from herd immunity. With the widespread use of the vaccine, emerging of non vaccine serotypes has been documented. The IPD burden in Thailand was found to be lower than that found in the western countries but the data in high risk population has been lacking. The PCV has been available in Thailand since 2006 as an optional vaccine, out of National Vaccine Program, with the uptake of less than 5% in children under 5 years of age. The serotypes distribution in Thailand has not changed significantly. In the year 2000-2005, compared with year 2006-2009, the most common serotypes in children < 5 years have been similar; comprising of 6B, 23F, 14, and 19F, however 19A has become more prevalence (6.2%) in the years 2006-2009. With the new breakpoint of penicillin susceptibility for non-meningeal strains, most penumococcal isolates in Thailand were susceptible to penicillin. To project the benefit for widespread use of PCV in Thailand the cost benefit analyses including the different types of PCV, the various dosing schedule, the benefit from herd immunity and the disadvantage of serotype replacement are needed. Source

Wattanakul T.,Chulalongkorn University | Avihingsanon A.,Red Cross | Avihingsanon A.,Chulalongkorn University | Manosuthi W.,Bamrasnaradura Infectious Diseases Institute | Punyawudho B.,Chulalongkorn University
Antiviral Therapy | Year: 2014

Background: Nevirapine-based antiretroviral therapy is widely used as a first-line treatment for HIV-infected patients in resource-limited settings. Nevirapine plasma concentration has been shown to be associated with virological response and treatment failure. Therefore, identifying sources of the variability of nevirapine pharmacokinetics is important for dose optimization. The purpose of the current study was to determine the population mean pharmacokinetic parameters and identify factors that influence pharmacokinetic parameters of nevirapine in Thai HIV-infected patients.Methods: The model was developed by a non-linear mixed-effects modelling approach using NONMEM. Model validation was performed using bootstrap analysis and external validation. Additionally, nevirapine plasma concentrations of 200 mg twice daily (NVPBID) and 400 mg once daily (NVPOD) were simulated using the final model to investigate the impact of the covariates and different dosage regimens on nevirapine steady state concentrations.Results: The apparent clearance (CL/F) of nevirapine estimated from this population was 2.51 l/h which is lower than the values previously reported in other populations. The concomitant use of rifampicin increased CL/F by 20%. Simulated nevirapine plasma concentrations from NVPBID were superior to the NVPOD regimen.Conclusions: This population-based pharmacokinetic model can be used for optimizing nevirapine dosage regimens for individual patients to improve efficacy and safety of nevirapine therapy in this population. © 2014 International Medical Press. Source

Manosuthi W.,Bamrasnaradura Infectious Diseases Institute | Mankatitham W.,Bamrasnaradura Infectious Diseases Institute | Lueangniyomkul A.,Bamrasnaradura Infectious Diseases Institute | Thongyen S.,Bamrasnaradura Infectious Diseases Institute | And 6 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2012

Background: Optimal timing for initiation of antiretroviral therapy (ART) among HIV-infected patients with tuberculosis (TB) is not well established. Methods: HIV/TB-coinfected patients were randomized to initiate tenofovir/lamivudine/efavirenz at 4 weeks (4-week group) or 12 weeks (12-week group) of TB treatment. The primary outcome was 1-year all-cause mortality. Results: Of 156 patients, 79 were in 4-week group and 77 in 12-week group. Overall, median (interquartile range) CD4 was 43 (47-106) cells per cubic millimeter and median (interquartile range) HIV-1 RNA was 5.8 (5.4-6.3) log copies per milliliter. Eleven (7%) mortalities occurred in a total follow-up period of 137 patient-years. Seven percent (6/79, 8.76 per 100 patient-years) mortalities were in 4-week group, and 6% (5/77, 7.25 per 100 person-years) mortalities were in 12-week group [relative risk (RR) = 0.845, 95% confidence interval (CI) = 0.247 to 2.893]. Twenty-eight (35%) patients in 4-week group and 25 (32%) patients in 12-week group were hospitalized (RR = 1.142, 95% CI = 0.588 to 2.217). Grade 2-4 adverse events were 39% (31/79) in 4-week group and 34% (26/77) in 12-week group (RR = 1.267, 95% CI = 0.659 to 2.435). In multivariate analysis, "low albumin" (RR = 2.695, 95% CI = 1.353 to 5.475) and "low baseline CD4 count" (RR = 4.878, 95% CI = 1.019 to 23.256) were the independent predictors of mortality. Immune reconstitution inflammatory syndrome was more frequent in 4-week group with an incidence of 8.86 versus 5.02 per 100 person-months in 12-week group over the first 6 months of ART (P = 0.069). Conclusions: In middle-income countries where ART is initiated at CD4 count of <350 cells per cubic millimeter, immediate initiation of ART in HIV-infected patients with active TB was not associated with survival advantage when compared to initiation of ART at 12 weeks. © 2012 by Lippincott Williams & Wilkins. Source

Discover hidden collaborations