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Chiang Kham, Thailand

Sripan P.,Chiang Mai University | Sripan P.,Institute Of Recherche Pour Le D Veloppement Ird Umi 174 | Ngo-Giang-Huong N.,Institute Of Recherche Pour Le D Veloppement Ird Umi 174 | Ngo-Giang-Huong N.,Chiang Mai University | And 20 more authors.
Chiang Mai Journal of Science

Exposure to single dose nevirapine during labor (SD-NVP) to prevent mother to child transmission of HIV (PMTCT) is associated with a lower likelihood of virologic suppression at six months of a nevirapine based antiretroviral therapy but long-term consequences of SD-NVP have not been studied. We analyzed data from women who received SD-NVP in the PHPT-2 PMTCT clinical trial. Following delivery, women initiated a regimen composed of nevirapine, lamivudine, and stavudine or zidovudine when their CD4 level declined to less than 250 cells/mm3. HIV RNA load and CD4 cell counts were evaluated every six months. Failure was defined as a confirmed HIV RNA load >400 copies/mL at least 6 months after therapy initiation, or death, and observations were censored at time of drop out or switch to a protease inhibitor based regimen. Survival analysis was performed using Kaplan-Meier estimates and Cox regression models. The 221 SD-NVP exposed women and 48 unexposed women had similar characteristics at baseline, except the time spent between delivery and initiation of therapy (6.1 and 14.9 months, respectively). At four years, 35% of the SD-NVP exposed and 14% of the unexposed women met the failure criteria (P=0.02). In the multivariable analysis, factors contributing to the failure consisted of exposure to SD-NVP (HR: 2.63, P=0.03), plasma HIV-1 RNA level above median (HR: 2.53, P<0.001), stage C of the CDC HIV clinical staging (HR: 2.12, P=0.04), platelets cell count above median (HR: 1.65, P=0.04) and early initiation of therapy after delivery (HR: 1.64, P=0.04). In this cohort, the impact of SD-NVP on further antiretroviral therapy was still significant after four years of therapy, justifying the use of strategies to prevent resistance mutations after exposure to SD-NVP. Source

Takeuchi D.,Osaka University | Kerdsin A.,National Institute of Health | Pienpringam A.,Chiang Kham General Hospital | Loetthong P.,Phayao Provincial Hospital | And 16 more authors.

Background: Streptococcus suis infection in humans has received increasing worldwide recognition. Methods and Findings: A prospective study of S. suis infection in humans was conducted in Phayao Province in northern Thailand to determine the incidence and the risk behaviors of the disease in this region in 2010. Thirty-one cases were confirmed. The case fatality rate was 16.1%, and the estimated incidence rate was 6.2 per 100,000 in the general population. The peak incidence occurred in May. The median age of the patients was 53 years and 64.5% were men. Consumption of raw pork products was confirmed in 22 cases and the median incubation period (range) was 2 days (0-11) after consumption of raw pork products. Isolates from 31 patients were confirmed as serotype 2 in 23 patients (74.2%) and serotype 14 in eight patients (25.8%). The major sequence types (STs) were ST1 (n = 20) for serotype 2 and ST105 (n = 8) for serotype 14. The epidemiological analysis suggested three possible clusters, which included 17 cases. In the largest possible cluster of 10 cases in Chiang Kham and its neighboring districts in May, the source of infection in four cases was identified as a raw pork dish served at the same restaurant in this district. Microbiological analysis confirmed that three of four cases associated with consumption of raw pork at this restaurant were attributable to an identical strain of serotype 2 with ST1 and pulsotype A2. Conclusions: Our data suggest a high incidence rate of S. suis infection in the general population in Phayao Province in 2010 and confirm a cluster of three cases in 31 human cases. Food safety control should be strengthened especially for raw pork products in northern Thailand. © 2012 Takeuchi et al. Source

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