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Chiang Rai, Thailand

Panyasai S.,University of Phayao | Thongsuk P.,Chiang Rai Prachanukroh Hospital | Pornprasert S.,Chiang Mai University
Hemoglobin | Year: 2016

Hb Agenogi [β90(F6)Glu→Lys (GAG>AAG) HBB: c.271G>A)] is a very rare β-globin chain variant. We report for the first time this hemoglobinopathy in a pregnant 20-year-old Thai woman. She was seen by an obstetrician at her 14th week of gestation. She was pale and had an inflammatory lesion of her lower left leg. The hemoglobin (Hb) analysis by high performance liquid chromatography (HPLC) and low pressure liquid chromatography (LPLC) showed a peak of abnormal Hb at the C window. On capillary electrophoresis (CE), the abnormal Hb peak was observed at electrophoretic zone 4 that corresponded to the Hb E (HBB: c.79G>A) peak. Direct DNA sequencing revealed a GAG>AAG mutation at codon 90 of the β-globin gene. Thus, even though Hb Agenogi is very rare, it can be found in Thai people. The knowledge and understanding of this hemoglobinopathy will be used to assist in diagnosis, management and counseling for patients. © 2016 Taylor & Francis. Source

Bunupuradah T.,Red Cross | Puthanakit T.,Red Cross | Puthanakit T.,Chulalongkorn University | Fahey P.,University of New South Wales | And 16 more authors.
Antiviral Therapy | Year: 2013

Background: The World Health Organization (WHO) recommends boosted protease inhibitor (bPI)-based HAART after failing non-nucleoside reverse transcriptase inhibitor (NNRTI) treatment. We examined outcomes of this regimen in Asian HIV-infected children. Methods: Children from five Asian countries in the TREAT Asia Pediatric HIV Observational Database (TApHOD) with ≥24 weeks of NNRTI-based HAART followed by ≥24 weeks of bPI-based HAART were eligible. Primary outcomes were the proportions with virological suppression (HIV RNA<400 copies/ml) and immune recovery (CD4+ T-cell percentage [CD4%]≥25% if age <5 years and CD4+ T-cell count ≥500 cells/mm3 if age ≥5 years) at 48 and 96 weeks. Results: Of 3,422 children, 153 were eligible; 52% were female. At switch, median age was 10 years, 26% were in WHO stage 4. Median weight-for-age z-score (WAZ) was -1.9 (n=121), CD4% was 12.5% (n=106), CD4+ T-cell count was 237 cells/mm3 (n=112), and HIV RNA was 4.6 log10 copies/ml (n=61). The most common bPIwas lopinavir/ritonavir (83%). At 48 weeks, 61% (79/129) had immune recovery, 60% (26/43) had undetectable HIV RNA and 73% (58/79) had fasting triglycerides ≥130 mg/dl. By 96 weeks, 70% (57/82) achieved immune recovery, 65% (17/26) hadvirological suppression, and hypertriglyceridaemia occurred in 66% (33/50). Predictors for virological suppression at week 48 were longer duration of NNRTI-based HAART (P=0.006), younger age (P=0.007), higher WAZ (P=0.020) and HIV RNA at switch <10,000 copies/ml (P=0.049). Conclusions: In this regional cohort of Asian children on bPI-based second-line HAART, 60% of children tested had immune recovery by 1 year, and two-thirds had hyperlipidaemia, highlighting difficulties in optimizing secondline HAART with limited drug options. © 2013 International Medical Press. Source

Kiertiburanakul S.,Mahidol University | Boettiger D.,University of New South Wales | Lee M.P.,Queen Elizabeth Hospital | Omar S.F.,University of Malaya | And 20 more authors.
Journal of the International AIDS Society | Year: 2014

Introduction: Although antiretroviral therapy (ART) has been rapidly scaled up in Asia, most HIV-positive patients in the region still present with late-stage HIV disease. We aimed to determine trends of pre-ART CD4 levels over time in Asian HIV-positive patients and to determine factors associated with late ART initiation. Methods: Data from two regional cohort observational databases were analyzed for trends in median CD4 cell counts at ART initiation and the proportion of late ART initiation (CD4 cell counts <200 cells/mm 3 or prior AIDS diagnosis). Predictors for late ART initiation and mortality were determined. Results: A total of 2737 HIV-positive ART-naïve patients from 22 sites in 13 Asian countries and territories were eligible. The overall median (IQR) CD4 cell count at ART initiation was 150 (46-241) cells/mm3. Median CD4 cell counts at ART initiation increased over time, from a low point of 115 cells/mm3 in 2008 to a peak of 302 cells/mm3 after 2011 (p for trend 0.002). The proportion of patients with late ART initiation significantly decreased over time from 79.1% before 2007 to 36.3% after 2011 (p for trend <0.001). Factors associated with late ART initiation were year of ART initiation (e.g. 2010 vs. before 2007; OR 0.40, 95% CI 0.27-0.59; p <0.001), sex (male vs. female; OR 1.51, 95% CI 1.18-1.93; p = 0.001) and HIV exposure risk (heterosexual vs. homosexual; OR 1.66, 95% CI 1.24-2.23; p=0.001 and intravenous drug use vs. homosexual; OR 3.03, 95% CI 1.77-5.21; p <0.001). Factors associated with mortality after ART initiation were late ART initiation (HR 2.13, 95% CI 1.19-3.79; p=0.010), sex (male vs. female; HR 2.12, 95% CI 1.31-3.43; p = 0.002), age (≥51 vs. ≤30 years; HR 3.91, 95% CI 2.18-7.04; p<0.001) and hepatitis C serostatus (positive vs. negative; HR 2.48, 95% CI 1. -4.36; p = 0.035). Conclusions: Median CD4 cell count at ART initiation among Asian patients significantly increases over time but the proportion of patients with late ART initiation is still significant. ART initiation at higher CD4 cell counts remains a challenge. Strategic interventions to increase earlier diagnosis of HIV infection and prompt more rapid linkage to ART must be implemented. © 2014 Kiertiburanakul S et al; licensee International AIDS Society. Source

Wiwattanawarang N.,Chiang Rai Prachanukroh Hospital
Journal of the Medical Association of Thailand | Year: 2014

Total knee replacement is an effective procedure for severely diseased knee joints; however, one of the major problems resulting in failure of arthroplasty is periprosthetic joint infection. Fungal infection is rarely found perprosthetic joints infection, but the incidence may be increased in high risk patients. Progression of the disease and definitive treatment guidelines have not yet been established. In two cases of fungal periprosthetic joint infection the organism was identified from cultures as Candida spp. Those patients had developed symptoms of pain and local knee inflammation six years after total knee replacement. A two-stage operation was carried out. The first operation removed the prosthesis, the polyethylene surface, the cement mantle and the infected tissue. After identification of the organism, the correct antibiotic was administered until the infection was controlled. A second operation was carried out to re-implant the prosthesis after the infection had subsided. A summary of reports in the literature regarding treatment of fungal periprosthetic infections as well as an algorithm for treatment decision making are presented. © 2014, Medical Association of Thailand. All rights reserved. Source

Cressey T.R.,Chiang Mai University | Cressey T.R.,Harvard University | Cressey T.R.,CIRAD - Agricultural Research for Development | Best B.M.,University of California at San Diego | And 13 more authors.
British Journal of Clinical Pharmacology | Year: 2013

Aim: To describe the pharmacokinetics and safety of indinavir boosted with ritonavir (IDV/r) during the second and third trimesters of pregnancy and in the post-partum period. Methods: IMPAACT P1026s is an on-going, prospective, non-blinded study of antiretroviral pharmacokinetics (PK) in HIV-infected pregnant women with a Thai cohort receiving IDV/r 400/100mg twice daily during pregnancy through to 6-12 weeks post-partum as part of clinical care. Steady-state PK profiles were performed during the second (optional) and third trimesters and at 6-12 weeks post-partum. PK targets were the estimated 10th percentile IDV AUC (12.9μgml-1h) in non-pregnant historical Thai adults and a trough concentration of 0.1μgml-1, the suggested minimum target. Results: Twenty-six pregnant women were enrolled; thirteen entered during the second trimester. Median (range) age was 29.8 (18.9-40.8) years and weight 60.5 (50.0-85.0) kg at the third trimester PK visit. The 90% confidence limits for the geometric mean ratio of the indinavir AUC(0,12h) and Cmax during the second trimester and post-partum (ante:post ratios) were 0.58 (0.49, 0.68) and 0.73 (0.59, 0.91), respectively; third trimester/post-partum AUC(0,12h) and Cmax ratios were 0.60 (0.53, 0.68) and 0.63 (0.55, 0.72), respectively. IDV/r was well tolerated and 21/26 women had a HIV-1 viral load < 40 copies ml-1 at delivery. All 26 infants were confirmed HIV negative. Conclusion: Indinavir exposure during the second and third trimesters was significantly reduced compared with post-partum and ∼30% of women failed to achieve a target trough concentration. Increasing the dose of IDV/r during pregnancy to 600/100mg twice daily may be preferable to ensure adequate drug concentrations. © 2013 The Authors. Source

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